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AMERICAN  MUSEUM  OF  NATURAL  HISTORY 


HANDBOOK  OF  HEALTH 
IN  WAR  AND  PEACE 

A  MANUAL  OF  PERSONAL 
PREPAREDNESS 


/ 


ISSUED  AT  THE 

OPENING  OF  THE  HEALTH  AND  FOOD  EXHIBITION 

OF  THE 

AMERICAN  MUSEUM  OF  NATURAL  HISTORY 
MAY  23, 1917 


PRICE  25  CENTS 


HANDBOOK  SERIES,  NO.  6 


AMERICAN  MUSEUM  OF  NATURAL  HISTORY 

HANDBOOK  OF  HEALTH 
IN  WAR  AND  PEACE 

A  MANUAL  OF  PERSONAL 
PREPAREDNESS 


BY 

C-E.  A.  WINSLOW 


WITH    FOREWORD   BT 


HENRY  FAIRFIELD  OSBORN 


PREPARED   AND  ISSUED  BT 

DEPARTMENTS  OF  PUBLIC  HEALTH  AND  PUBLIC 
EDUCATION  OF  THE  AMERICAN  MUSEUM 

OF  Natural  History 
NEW  YORK,  1917 


PUBUO 

HEALTH 
LIBRARY 


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FOREWORD 

There  has  never  been  a  period  in  American  history  when 
diffusion  of  knowledge  of  the  laws  of  nature  was  a  more  im- 
mediate and  a  more  imperative  duty  than  at  the  present 
time.  Hundreds  of  thousands  of  young  men  and  young 
women  are  ready  to  offer  their  services  and,  if  need  be, 
their  lives  for  their  country  and  for  the  great  principles  of 
loyalty,  truth,  justice,  humanity  and  liberty  for  which  our 
President  has  enlisted  us  in  this  world  war.  But  let  not  a 
single  life  be  lost  needlessly.  Let  no  constitution  be  broken 
by  disease  through  ignorance.  The  patriotic  opportunity  of 
all  men  of  science  is  to  spread  the  truth,  and  to  spread  it  as 
quickly  as  possible.  Let  us  speak  plainly  of  all  the  dangers 
and  enemies  which  surround  the  soldier  and  the  sailor,  of 
those  that  kill  the  soul  as  well  as  those  which  destroy  the 
body.  The  loss  to  the  world  of  the  finest  strains  of  manhood 
is  the  most  awful  curse  of  the  many  curses  attending  this 
war.  Every  young  man,  if  single,  must  think  of  his  future 
wife,  of  his  future  home,  of  his  future  children  and  so  live 
that,  if  his  life  is  spared,  he  may  some  day  give  to  his  coun- 
try one  of  the  greatest  gifts  it  is  in  a  man's  and  woman's 
power  to  give — healthy  and  patriotic  offspring.  It  is  a 
scientific,  no  less  than  a  religious  principle,  that  to  serve 
one's  country  one  must  be  sound  in  body,  sound  in  mind, 
and  sound  in  spirit. 

In  opening  a  food  and  health  exposition,  the  American 
Museum  is  in  cooperation  with  the  Council  of  National 
Defence  and  especially  wdth  its  Medical  Board,  also  viith 
the  National  Food  Commission  under  Herbert  C.  Hoover. 

Henry  Fairfield  Osborn, 

President. 


3 

3G135S 


T 


HEALTH  AS  A  NATIONAL  DUTY 

War  is  no  longer  a  conflict  of  armies  but  a  struggle  be- 
tween   nations.     Behind    the   gallant    bat-    ^^^^  -ppcnnnci 
talions  in  the   field   there  must  be   other 


battalions  in  the  munition  factories  and  on   „    .       i  r  '  ' 
the  farms  whose  devotion  is  equally  essen- 
tial to  national  victory.     Success  demands  the  coordinated 
individual  efficiency  of  the  whole  people;  and  individual 
efficiency  rests  upon  health. 

As  the  United  States  enters  upon  a  great  war  for  liberty, 
for  justice  and  for  humanity,  there  arises  in  all  of  us  a  new 
sense  of  common  responsibility,  a  new  determination  to 
reach  the  highest  level  of  effectiveness.  There  is  no  place 
any  more  for  carelessness,  for  meddling,  for  self-indulgence. 
There  is  no  place  for  preventable  disease. 

Health  is  to-day,   as  never  before,   a  national    duty — 
health  not  merely  in  the  sense  of  freedom         xr     ifv,       a 
from  acute  sickness,  but  in  the  sense  of  full         p_  . 
abounding  vigor  and  vitality  and  power. 
The  maintenance  of  such  vigor  and  vitality  depends  on 
simple  principles  of  hygiene  and  sanitation.     It  has  been 
truly  said  that  "within  natural  limitations,  a  community 
can  determine  its  own  death  rate."     It  is  equally  true  that 
"within  natural  limitations,  an  individual  can  determine  his 
own  physical  efficiency." 

It  is  in  the  belief  that  thousands  of  men  and  women  in 
training  camps  and  in  munition  factories,  on  farms  and  in 
homes,  are  determined  in  this  hour  of  trial  to  give  their  best 
to  their  country  that  this  Handbook  of  Health  and  Efficiency 
has  been  prepared  by  the  Ariierican  Museum  of  Natural 
History  and  dedicated  to  an  awakened  and  a  reborn  America. 
5  ^ 


;  :•■ :  ;■  .    .FUEL  FOR  THE  LIVING  MACHINE 

The  food  is  the  fuel  which  runs  our  hving  machine,  just 
.  as  truly  as  coal  is  fuel  for  an  engine.  Ex- 
periments in  physiological  laboratories  have 
shown  that  in  a  man,  as  in  any  other  well-made  machine, 
you  get  out  an  amount  of  work  and  heat  that  corresponds 
directly  to  the  amount  of  fuel  put  in. 

Our  first  food  need,  then,  is  for  a  sufficient  supply  of 
energy.  Food  energy  is  measured  in  calories,  one  calorie 
being  the  amount  of  heat  energy  necessary  to  raise  the 
temperature  of  one  kilogram  (about  two  pints)  of  water 
one  degree  on  the  centigrade  thermometer.  Three  large 
lumps  of  sugar,  one  large  banana,  one  very  large  egg,  one 
chop,  two  thin  slices  of  bread,  two  apples,  one  pat  of  butter, 
two-thirds  of  a  glass  of  milk — each  of  these  food  portions 
contains  about  100  calories.  The  average  adult  needs  about 
2,500  calories  a  day  if  leading  a  sedentary  life,  3,000  calories 
if  engaged  in  active  physical  work. 

The  individual  soldier  has  his  dietary  needs  cared  for  by 
those  in  authority.  For  the  civil  population  and  for  the 
nation  as  a  whole,  however,  the  question  of  the  food  supply 
is  a  vital  one  in  war  time,  and  particularly  at  the  present 
moment  when  the  food  supplies  of  Europe  are  exhausted  and 
the  whole  allied  world  depends  on  America  to  preserve  it 
from  starvation. 

The  attainment  of  proper  national  dietary  standards  de- 

.    ..      pends  partly  on  the  available  food  supply 

Economy  in  the  ^^^  ^^^^^^  ^^  ^^^  intelligent  selection  and 

Selection  of         ^^^  ^^  ^^^^^     r^,^^  ^^^^  ^^  ^^^  calories  in 

®     ^^  different  forms  varies  enormously;  and  by 

learning  to  make  an  intelligent  selection  every  individual 
purchaser  and  eveiy  individual  householder  can  help  in  the 
great  task  of  food  conservation. 

The  following  table,  from  "The  Fundamental  Basis  of  Nu- 
trition," by  Graham  Lusk,  shows  the  cost  of  1,000  calories  in 
6 


the  foi-m  of  various  staple  foods.  The  actual  prices  would 
be  higher  now  than  in  1913,  but  the  figures  are  significant 
of  more  or  less  constant  relative  differences.  The  economy 
in  such  foods  as  cornmeal,  wheat  flour,  beans  and  pork  as 
compared  with  mutton,  beef  and  codfish  is  worthy  of  special 
note. 

Cost  in  Cents  of  1,000  Calories 

(Lusk) 

Glucose 134  Butter 10 

Cornmeal 2  Milk 10 

T\Tieat  flour 2}4  Smoked  ham lO^^ 

Oatmeal 24/5  Cheese 11% 

Cane  sugar 33^  Loin  pork 123^ 

Dried  beans 4  Mutton  (leg) 16^^ 

Salt  pork  (fat) 43^  Salt  cod 193^ 

Rice 5  Sirloin  beef 24 

Wheat  bread 5}4  Turkey 40 

Oleomargarin 73^  Codfish  steak  (fresh) . .  .42 

Potatoes 73^ 

The  supply  of  a  suSicient  calorie  allowance  is,  of  course, 

only  a  part  of  the  problem.     The  body  not    _    ,    u  -u- 

1         ^  r         -^     r    J   u  /    1       Body-buildmg 

only  gets   energy  from   its  food  but   also    _     "l 

builds  up  out  of  the  foods  its  own  substance 
which  is  constantly  being  consumed  as  a  result  of  the  life 
process.  Muscle  and  bram  and  all  the  other  tissues  of  the 
body  are  wasting  away  minute  by  minute  and  second  by 
second,  and  the  waste  must  be  made  good  from  the  sub- 
stances in  the  food.  Some  of  the  elements  in  living  tissue 
are  present  in  almost  all  food  substances  and  are  sure  to  be 
supplied  in  sufficient  amounts  in  any  diet  which  will  furnish 
2,500-3,000  calories  of  energy.  Other  building  stones  of  the 
body  are  found  only  in  certain  foodstuffs. 

The  most  important  of  these  building  stones  are  found  in 
the  nitrogen-containing  foodstuffs  known  as  proteins,  of  which 
7 


white  of  egg  and  lean  meat  are  examples.  So  important  are 
these  substances  that  many  authorities  have  divided  foods 
into  two  main  groups. 

(1)  Body-builders  and  repairers.  (Protein,  chiefly  con- 
tained in  meat,  eggs,  milk,  peas,  beans,  kernels,  grain,  etc.) 

(2)  Energy-producers,  yielding  heat  and  work.  (Fats, 
and  oils  [hydrocarbons]  with  sugar  and  starch  [carbohj^- 
drates].) 

A  definite  proportion  of  protein  food  (10-15  per  cent.)  is 
an  absolute  essential  of  the  diet,  and  people  who  fail  to  get 
a  sufficient  amount  of  such  food  quickly  show  the  result  in 
diminished  vigor.  Pellagra,  a  serious  disease  which  occurs 
particularly  among  the  poor  population  of  our  southern 
states,  is  closely  connected  with  a  diet  poor  in  protein,  and 
can  be  cured  by  the  substitution  of  one  rich  in  meat,  eggs  and 
milk. 

The  table  below,  showing  the  classification  of  certain  com- 
mon foodstuffs  according  to  their  richness  in  proteins  and 
fats,  is  taken  from  the  excellent  handbook  on  "How  to  Live," 
by  Prof.  Irving  Fisher  and  Dr.  E.  L.  Fisk.  Foods  low  in 
both  proteins  and  fats  are  composed  chiefly  of  carbohy- 
drates (sugar  and  starches). 

Common  Foods  Classified 


Poor  in  Fat 

Rich  in  Fat 

White  of  eggs 

Very  high 

Codfish 

in 

Lean  beef 

Protein 

Chicken 
Veal 

Shellfish 

Most  fish 

High  in 

Skim  milk 

Most  meats 

Protein 

Lentils 

Most  fowl 

Peas 

Whole  egg 

Beans 

Cheese 

Poor  in  Fat                 Rich  in  Fat 

Very  Rich 
in  Fat 

Moderate 

Most  vegetables    Peanuts 

Fat  meats 

or 

Bread                     Milk 

Yolk  of  eggs 

Deficient 

Potatoes                 Cream  soups 

Most  nuts 

in 

Fruits                     Most  pics 

Cream 

Protein 

Sugar                     Doughnuts 

Butter 

Mineral 

salts,  such  as  lime,  iron,  etc.,  are 

also  essential  to 

the  body  and  there  are  peculiar  substances 

Importance  of 

^ailC^  Vl^a.XX.lX10  y^^^^.^V  XXX  V^..C*X.X  .WV.^0,  y^g^y 

such  as  fruits,  unpolished  rice,  etc.,  which  .  „  , 
are  necessary  for  its  normal  development. 
The  disease  beri-beri  among  the  Philippine  scouts  was  due 
to  the  lack  of  such  substances  in  a  diet  made  up  largely  of 
polished  rice,  and  was  cured  by  a  change  in  diet.  As  wide 
a  variety  of  foods  as  possible  should  be  included  in  the  diet, 
and  fads  as  to  the  avoidance  of  certain  foodstuffs  frowned 
upon.  A  certain  proportion  of  hard,  bulky  and  indigestible 
foods,  such  as  crusts,  fibrous  vegetables  and  nuts,  is  essen- 
tial to  the  proper  working  of  the  bowels.  Ample  protein, 
salts  and  vitamins  will  be  secured  by  the  normal  instincts 
if  unhampered  by  economic  limitations,  so  that  the  whole 
question  comes  down  to  one  of  costs.  Professor  Lusk  esti- 
mates that  the  average  cost  of  a  group  of  staple  articles  has 
increased  from  11  cents  in  1916  to  18  cents  in  1917  for  an 
amount  that  would  supply  2,500  calories.  To  help  meet 
the  problem  of  this  increased  cost  of  living  he  has  prepared 
the  following  low-cost  meatless  dietary  of  high  caloric  value, 
designed  for  a  family  of  five  persons,  the  father  at  work 
and  the  mother  doing  household  work.  Potatoes,  with 
their  valuable  alkaline  salts,  had  to  be  excluded  from  the 
diet  because  of  their  prohibitive  price.  The  cost  amounted 
to  SI.  16  daily  for  14,400  calories,  or  eight  cents  per  thousand 
calories,  which  is  not  a  high  price: 


9 


Low-Cost  Meatless  Dietary  of  High  Efficiency  Value 

FOR  a  Family  of  Five  Persons,  Father  at  Work 

AND  Mother  doing  Household  Work 

Essentials. — Do  not  buy  meat  until  you  have  bought 
three  quarts  of  milk  a  day.  Milk  contains  valuable  tissue- 
building  food,  valuable  salts  and  invaluable  vitamins  which 
help  toward  sound  health. 

If  you  buy  bread  remember  that  day-old  bread  is  much 
cheaper  than  freshly  baked  bread  and  is  just  as  good  a  food. 

The  menus  may  be  arranged  as  follows: 

BREAKFAST 

Cornmeal  mush,  fried  (+milk  for  children  and  corn  syrup  for 
adults),  or  oatmeal,  or  hominy,  or  farina,  or  buckwheat 
cakes. 

Bread  (or  toast) . 

Oleomargarin. 

Coffee  (adults). 

Stewed  prunes. 

Orange  juice  for  baby. 

LUNCHEON    OR   SUPPER 

Pork  and  beans  (bean  soup  for  young  children),  or  creamed 

dried  beef  on  toast. 
Bread. 

Oleomargarin. 

Tea  with  milk  and  sugar,  for  adults. 
Milk  for  youngest  children. 
Cereal,  coffee  or  cocoa  for  older  children. 
Sliced  bananas  with  sugar,  or  stewed  dried  peaches.    (The 

bananas  may  be  boiled  in  their  skins.) 

DINNER 

Lentil  soup  (or  potato,  or  bean,  or  pea  soup). 
Boiled    rice    (or    spaghetti,   or  macaroni  with  cheese,   or 
baked  split  peas  with  bacon). 
10 


Tomato  catsup. 

Bread. 

Oleomargarin. 

Tea  for  adults. 

Milk  for  youngest  child. 

Dried-apple  pie  with  cheese,  for  adults. 

Dried-apple  sauce  for  others. 

The  Approximate  Cost  per  Day  and  the  Nutritive 
Values  in  Calories  Appear  Below 

Cost  in 
Amount  Calories     Cents 

Coffee 23/3  ounces  ....  3 

Tea Y2  ounce            2 

Milk 3      quarts  1,800  27 

Bread 2      pounds  2,500  9 

Cereal Yi  pound  800  4 

Oleomargarin %  pound  2,500  19 

Corn  syrup Y^  pound  650  2 

Sugar Y  pound  450  2 

Rice  or  macaroni 1      pound  1,600  8 

Dry  navy  beans 10      ounces  1,000  7 

Fat  pork 6 J^  ounces  1,000  6 

Dr}^  fruit  (prunes) 1      pound  325  12 

Flour,  lard,  etc.,  for  pie  or 

other  extras 1,800  15 

14,425  116 

As  cheaper  meats,  pork  sausages,  braised  chuck  rib  of 
beef,  salt  cod  or  herring  may  be  added  if  finances  allow. 

The  amount  and  hence  the  cost  of  food  available  for  the 

poor  depend  directly  on  the  amount  wasted     _.  , 

by  the  well-to-do;  and  it  is  the  duty  of  _,  ,    , 

A       •        /      •  •  ^^\-  Rule  for 

everv  American  to  give  serious  attention  „ 

^      ".  ^.  »    T  ^        ^  •  •  Economy  in 

to  this  question.     A  diet  containing  a  sur-  -. 

plus   of  meat,    fish   and   eggs   is  not   only 

wasteful  but  positively  harmful,   since  proteins  in  excess 

11 


decompose  in  the  intestines  and  poison  the  body.  An  ex- 
cellent general  rule  in  this  connection  has  been  suggested 
by  Prof.  H.  C.  Sherman,  who  advises  that  the  average 
family  should  spend  as  much  for  fruits,  vegetables  and  milk 
as  for  meat,  fish  and  eggs,  and  as  much  for  vegetables  and 
fruits  as  for  milk  and  eggs. 

Wastage  in  purchasing  and  preparation  of  foods  is  another 

StontheW    t     ii^^PO'^tant  cause  of  dietary  deficiency.    The 

r-p     ,  following  suggestions  indicate  some  of  the 

special  ways  in  which  the  housewife  can 

economize. 

Go  to  the  store  yourself  and  select  the  food,  with  a  view 
to  quality  and  cost.  Be  sure  you  get  full  weight  and  take 
home  for  soup  or  stew  all  bones  and  trimmings. 

Buy  the  cheaper  cuts  of  meat.  They  are  in  many  cases 
more  nourishing  than  the  more  costly  ones,  and  can  be  made 
tender  by  proper  cooking  and  seasoning.  The  cheaper  cuts 
of  meats  cost  only  one-half  as  much  as  the  round  and  sirloin. 

Buy  in  quantity  if  possible. 

Use  fish  instead  of  meat  as  much  as  possible. 

Milk,  cheese  and  beans  are  cheaper  than  meat  and  con- 
tain all  necessary  nutrients. 

Use  a  fireless  cooker,  which  saves  time,  fuel  and  food  value. 

Buy  fruits  and  vegetables  only  when  in  season. 

Buy  foods  in  bulk,  not  in  packages. 

Omit  luxuries  and  foods  of  low-energy  value. 

Save  left-overs. 

PURE  FOODS  AND  CLEAN  FOODS 

In  war  time  we  should  welcome  the  introduction  of  cheap 

y  .         -  food  substitutes  or  the  marketing  of  second- 

o         J  >->     J       grade  foods  if  they  are  really  valuable  and 

Second-Grade    ?,   ^,  ,/  u      r^  u   ^ 

p     ,  if   they    are    sold   as    such.      Cold-storage 

products  are  usually  not  as  palatable  as 

fresh  meats;  but  cold  storage  has  vastly  increased  the  food 

12 


resources  of  the  world  by  conserving  the  excess  of  one  season 
and  one  locality  for  use  at  other  times  and  places.  Skim 
milk  is  a  highly  valuable  food  material  which  should  be  sold 
freely  if  properly  labeled.  There  are  butter  substitutes  on 
the  market  which  are  as  valuable  for  food  as  real  butter 
and  cost  but  half  as  much. 

The  purity  in  foods  is  mainly  a  question  p    'tv      A 

of  honesty.     Clean  food,  on  the  other  hand,  _.       .. 

is  a  vital  essential  of  health. 

Polluted  water  in  the  past  has  been  a  common  cause  of 

disease  both  in  the  camp  and  in  civil  life.   _  , 

All  surface  water  supplies,  lakes  and  streams  t,  „   ,    ,  „,  . 

,.  ,,    ^        iw-      r  t         PoUuted Water 

are  liable  to  pollution  from  sewers  or  from 

material  washed  in  from  the  banks,  and  wells  and  springs 
may  be  polluted  through  crevices  in  the  soil.  No  water 
should  ever  be  drunk  if  there  is  any  uncertainty  as  to  its 
quality.  The  water  for  troops  in  the  field  should  be  purified 
by  filtration  or  disinfection,  and  it  is  one  of  the  first  duties 
of  the  soldier  to  avoid  the  use  of  any  unauthorized  supplies. 
Water  of  doubtful  quality  may  be  made  safe  by  boiling  or 
by  the  addition  of  chloride  of  lime.  Dissolve  a  teaspoonful 
of  chloride  of  lime  in  four  pints  of  water  and  add  one  teaspoon- 
ful of  this  solution  to  a  gallon  of  the  water  to  be  purified 
(one  tablespoonful  to  four  gallons,  ten  tablespoonfuls 
to  a  barrel).  The  water  should  stand  for  half  an  hour 
before  use. 

Milk  is  another  food  which  often  carries  the  germs  of 
disease,  germs  of  tuberculosis  from  the  cow,       _^  , 

or   gei-ms    of   typhoid   fever,    sore   throat,       Twr-iif 
diphtheria,    etc.,  from  human  beings  who 
have  handled  it.      Milk  should  always    be   pasteurized   or 
heated  to  140°- 145°  F.  for  20  to  30  minutes  before  it  is  used, 
and  on  no  account  should  uncooked  cow's  milk  be  given  to 
young  children. 

The  best  way  to  pasteurize  milk  in  the  home  is  to  set  the 
bottles  in  a  deep  pan  of  water  on  the  stove,  put  a  milk 
13 


thermometer    into    the    water,  heat    to  about    145°  F.    or 
a   little    over,  -  and  then    set    the  pan  on 
.  the  back  of  the  stove,  moving  it  back  and 

forth  now  and  then  to  keep  the  tempera- 
ture, for  half  an  hour,  as  near  145°  as 
possible,  say  between  140°  and  145°.  If  no  milk  thermometer 
is  at  hand  it  will  be  almost  as  well  to  heat  the  pan  till 
the  water  boils  and  then  let  it  stand  on  the  back  of  the 
stove  for  half  an  hour,  although  this  may  give  the  milk  a 
slight  cooked  taste. . 

Foods  of  all  sorts  should  be  carefully  protected  from  dust 

_^,       „  ,  and  fhes,  which  may  carry  disease  germs, 

Other  Safe-  ,  -  r,     jr         Ti.  •    • 

,    ,  and  from  unnecessary  handlmg.     It  is  im- 

°;  portant  that  foods  should  not  be  handled 

by  those  who  are  "coming  down"  with  any 

communicable  disease;  and  foods  to  be  eaten  raw  should  be 

purchased  only  from  careful  and  responsible  dealers.     The 

greatest  care  should  be  taken  to  avoid  tainted  meats  and  to 

keep  perishable  foods  from  spoiling. 


EXERCISE  AND  REST 

The  heart,  the  lungs,  the  blood  vessels,  the  bowels  de- 
generate if  they  are  not  given  their  proper 
Value  of  work  to  do,  and  on  the  other  hand  they 

Exercise  suffer  if  too  heavj^  a  burden  is  placed  upon 

them. 

The  muscles  make  up  more  than  one-half  the  total  weight 
of  the  human  body,  and  their  proper  use  is  essential,  not 
only  for  their  own  gro\\i;h  but  on  account  of  the  inter- 
relation between  the  health  of  the  muscles  and  that  of  the 
rest  of  the  organs.  Vigorous  physical  exercise  not  onlj'  de- 
velops the  muscles  themselves,  it  stimulates  the  heart  and 
the  blood  vessels,  it  deepens  the  breathing,  it  keeps  up  the 
tone  of  the  digestive  system,  it  frees  the  tissues  from  the 
accumulation  of  harmful  waste  products. 
14 


The  physique  of  the  recruit  is  systematically  developed 
by  setting-up  exercises,  marching,  rifle  and  Avoidance  of 
sabre  exercises,  applied  gymnastics,  swim-  Overstrain 
ming  and  athletic  games.  It  is  overstrain 
which  the  soldier  must  avoid,  and  "soldier's  heart"  has  been 
a  common  complaint  in  Europe  during  the  present  war. 
Exercises  should  be  varied  so  as  not  to  overtax  any  one 
group  of  muscles  and  they  should  never  be  carried  to  the 
point  of  exhaustion.  Breathlessness  is  a  valuable  danger 
signal  of  overload  of  the  heart. 

It  is  not  hard  work  that  kills.  It  is  prolonged  strain  at 
dull  tasks  without  variety,  on  the  one  hand,  ^     tad 

worry  and  excitement  on  the  other.    With  p,_,  . 

a  proper  variety  of  work  it  is  marvellous 
what  the  human  mind  and  hand  can  accomplish,  but  they 
cannot  endure  too  long  a  pull  without  interruption.  The 
operatives  in  the  Zeiss  Optical  Works  at  Jena  actually  did 
more  work  in  an  eight-hour  day  than  in  one  of  nine  hours. 
They  could  keep  fresh  and  vigorous  for  the  shorter  period, 
while  they  began  the  nine-hour  day  in  poor  condition  be- 
cause imperfectly  rested  from  the  day  before. 

The  studies  made  in  the  English  munition  factories  dur- 
ing the  present  war  have  shown  clearly  that  a  limitation  of 
hours  of  labor  may  often  lead  to  such  an  increase  in  pro- 
duction; and  this  is  a  lesson  we  must  bear  in  mind  in  this 
country  in  the  present  crisis. 

The  first  rule  of  the  hygiene  of  rest,  then,  is  to  avoid  so 
far  as  possible  overstrain  due  to  prolonged  ^         , 

work   of   a   similar   kind.     People   vary   a  Restine 

good  deal  in  their  rest  needs.  Some  men 
are  rested  by  a  change  of  work,  some  by  active  play  and 
some  by  complete  rest.  Nothing,  however,  can  take  the 
place  of  necessary  sleep,  and  the  average  individual  needs 
about  eight  hours  of  sleep  out  of  the  twenty-four.  No  one 
can  work  hard  all  day  and  play  half  the  night.  Nervous- 
ness and  irritability  are  danger  signals.  They  mean  that 
15 


the  strength  is  being  overtaxed  and  that  some  change  in 
habits  should  be  made. 

Cultivation  of  mental  poise  is  a  great  help  in  conserving 
vital  force.  Worry  is  as  bad  as  monotony  and  a  fit  of  anger 
poisons  the  whole  system  and  is  more  exhausting  than  a 
hard  day's  work. 

POSTURE  AND  RESPIRATION 

Standing  still  properly  is  one  good  form  of  exercise. 
_  Posture  depends  on  the  muscles  which  con- 

_  ,  trol  the  position  of  different  parts  of  this 

_        .  framework.     With  the  same  equipment  of 

bones,  one  body  may  be  stoop-shouldered 
and  slouching  and  another  may  be  erect  and  well-knit. 
One  of  the  most  immediate  good  results  of  military  training 
is  correct  posture,  which  involves  the  exercise  of  all  the 
hundreds  of  muscles  which  help  to  hold  the  body  well. 

The  backbone,  as  we  have  seen,  is  meant  to  be  slightly 

_  .,      ,  „    ,        cm-ved,  so  as  to  give  elasticity.     In  people 
Evils  of  Bad  ,       ,'        ^     ■.  .     ^     1    •  u^  \i. 

who   do   not   sit   or  stand   straight,    these 

curves  become  greatly  exaggerated,  leading 

to  round  shoulders  and  a  drooping  head.     Such  bad  posture 

is  not  only  ungraceful  but  unhealthy.     If  the  back  and 

shoulders  and  abdominal  wall  are  not  held  properly  the 

lungs  do  not  get  sufficient  aeration  and  the  internal  organs 

are  crowded  together  and  their  blood  supply  hampered. 

Many  and  grave  disorders  are  traced  to  faulty  posture  and 

are  cured  by  improving  it. 

When  standing  correctly,  the  head,  body  and  legs  should 

he  poised  one  above  the  other  so  that  a 

line  dropped  from  the  front  of  the  ear  falls 

within  the  forward  half  of  the  foot.     "This 

is  the  position  of  the  long-distance  walker,  the  mountain 

climber,  the  best  all-round  athletes;  it  is  the  position  of 

command  and  authority,  and  is  found  predominant  in  the 

16 


great  leaders  of  commerce  and  public  life.  On  the  other 
hand,  collapsed  positions  are  characteristic  of  both  physical 
and  mental  weakness.  They  constitute  a  distinct  aspect 
of  weakness  and  illness,  from  the  tuberculosis  patient  to 
the  feeble-minded."  * 

In  sitting,  the  body  should  be  bent  only  at  knees  and 
hips,  and  the  head,  neck,  and  trunk  should  be  kept  in  one 
straight  line. 

Another  important  element  in  hygiene  is  the  exercise  of 
the  organs  of  breathing.    In  ordinary  breath-  _ 

ing  only  about  ten  per  cent,  of  the  lung  _     ^.  . 

contents  is  changed  at  each  breath,  and  the 
remoter  air  sacs  of  the  lungs  which  are  not  properly  exer- 
cised are  peculiarly  liable  to  disease.  The  high  mortality 
from  tuberculosis  among  clerks,  bookkeepers,  telegraphers 
and  other  indoor  workers  whose  tasks  require  or  invite  a 
stooping  posture  are  examples  of  such  harmful  effects. 
"A  hundred  deep  breaths  a  day"  is  one  physician's  recipe 
for  tuberculosis,  according  to  Fisher  and  Fisk.  Deep 
breathing  should  be  slow  and  not  forced. 

FRESH  AIR 

Variations  in  the  chemical  composition  of  the  air  are  of 

little  practical  moment,  except  for  the  pres-    „„      ^^    ,    *  • 
e  c  J   J    ^       J        Why  Bad  Air 

ence  of  poisonous  fumes  and  dust  under    -    ^t       r^  i 

special  industrial  conditions.  Even  in  the 
worst  ventilated  room  the  proportions  of  carbon  dioxid  and 
oxygen  never  change  sufficiently  to  produce  harmful  physi- 
ological effects.  The  discomfort  and  injury  to  health  that 
come  from  living  in  badly  ventilated  rooms  are  due  not 
primarily  to  any  chemical  changes  but  to  the  rise  in  tem- 
perature that  obtains  under  such  conditions. 

This  does  not  mean  that  fresh  air  is  unimportant,  but 
quite  the  contrary.     A  badly  ventilated  room  is  generally 
*  Jessie  H.  Bancroft,  in  The  Teaching  of  Hygiene. 
17 


an  overheated  room.     In  such  a  room  the  blood   vessels 

_„    ^     ,  of  the  skin  are  dilated,  the  body  tempera- 

Effects  of  ^  •  XI,  1         •  XI       vTi      J 

^      ,       .  ture   rises,   the  pulse   mcreases,  the  blood 

pressure  falls.  The  brain  and  inner  organs 
are  robbed  of  blood.  One  feels  dull  and  hstless  and  disin- 
clined to  exertion.  The  New  York  State  Commission  on 
ventilation  showed  that  when  there  was  a  powerful  incentive 
exertion  was  possible  for  short  periods  at  high  temperatures, 
but  that  under  ordinary  conditions  6  per  cent,  more  work 
was  done  at  68°  than  at  75°  and  15  per  cent,  more  than  at 
86°.  Prof.  Ellsworth  Huntington,  from  exhaustive  studies 
of  the  effect  of  season  and  climate  upon  physical  and  mental 
work,  finds  a  mean  outdoor  temperature  of  60°-64°  most 
favorable  for  efficiency,  summer  and  winter  both  showing  a 
marked  falling  off  as  compared  with  fall  and  spring.  It 
cannot  be  doubted  that  the  excessive  temperatures  main- 
tained in  many  factories  (often  combined  with  high  humid- 
ities, which  accentuate  the  effect  by  checking  evaporation 
of  perspiration)  militate  very  seriously  against  industrial 
efficiency.  In  militaiy  life  the  important  influence  of  climate 
upon  bodily  vigor  should  be  borne  constantly  in  mind  in 
the  selection  of  training  camps. 

The  avoidance  of  gross  overheating  (temperatures  above 
68°)  is  not  the  only  factor  to  be  considered. 
^  The  body  must  be  protected  against  the 

debilitating  effect  of  heat  on  the  one  hand 
and  against  the  shock  of  excessive  chilling  on  the  other. 
Within  reasonable  limits,  however,  variations  in  tempera- 
ture, and  particularly  movement  of  the  air,  are  important 
factors  in  promoting  health.  The  body  owes  its  marvellous 
power  of  maintaining  its  own  temperature  constant  through 
a  wide  range  of  outside  temperatures  to  the  reaction  of  the 
skin  blood  vessels,  which  contract  to  keep  the  blood  out  of 
the  skin  when  it  is  cold  and  expand  and  bring  the  blood  to 
the  surface  when  a  more  rapid  heat  loss  is  desired.  The 
tiny  muscles  in  the  walls  of  these  blood  vessels  must  be  ex- 
18 


erciscd  like  any  other  muscles  if  they  are  to  be  kept  in.  good 
condition.  In  a  person  who  Uves  habitually  in  an  even 
high  temperature  the  blood  vessels  do  not  respond  readily 
to  sudden  change.  In  such  people,  the  mucous  membranes 
of  the  nose  are  constantly  congested  (filled  with  blood  and 
lymph)  as  the  blood  vessels  dilate  to  keep  the  body  at  the 
proper  temperature.  As  a  consequence,  these  membranes, 
instead  of  shrinking  and  diying  promptly  as  they  should 
when  they  come  in  contact  mth  cold  outer  air,  lose  their 
quickness  of  response  and  stay  moist  and  swollen  even  after 
the  blood  vessels  themselves  have  contracted;  this  makes 
them  an  excellent  breeding  place  for  bacteria.  People  who 
have  been  weakened  in  this  way  are  very  sensitive  to  the 
cold  air  and  are  easily  subject  to  chills.  Benjamin  Franklin 
once  said,  "People  who  live  in  the  forest,  in  open  barns,  or 
with  open  windows,  do  not  catch  cold,  and  the  disease  called 
a  cold  is  generally  caused  by  impure  air,  lack  of  exercise, 
or  from  overeating."  Science  has  amply  confirmed  these 
observations  of  our  great  natural  philosopher. 

Fresh  air,  then,  means  air  that  is  not  too  hot,  or  too  cold, 
or  too  even  in  temperature, — air  that  is  _..,  ^  , 
pleasantly  cool  and  in  moderate  motion.  ..  . 
If  the  thermometer  reaches  70°  (except  in  the 
case  of  elderly  people,  who  may  require  a  higher  tempera- 
ture) it  is  a  sign  that  the  window  should  be  opened.  It  is 
particularly  important  to  have  plenty  of  fresh  air  in  the 
sleeping  room  and  windows  should  be  kept  well  opened  at 
night  even  in  cold  weather. 

HYGIENE  OF  CLOTHING  AND  BATHING 

The  clothing  should  protect  against  extremes  of  cold,  and 
this  is  particularly  necessary  after  exercise        n     rt*       f 
when  the  skin  blood  vessels  are  dilated  and        j'     p,  .t^. 
the  body  bathed  in  perspiration.     Woolen 
clothes  may   be  desirable  under  such   conditions   because 
19 


wool  being  porous  is  a  poor  conductor  of  heat  and  also  be- 
cause it  takes  up  moisture  readily  and  so  absorbs  and  holds 
the  perspiration. 

Cotton,  and  particularly  linen,  are  rapid  conductors  of 
heat  and  do  not  absorb  moisture,  so  that 
they  are  more  suitable  for  wann  weather. 
It  is  quite  as  undesirable  to  wear  clothes 
that  are  too  warm  as  to  expose  the  body  to  undue  chill.  If 
the  skin  cannot  get  rid  of  its  heat  fast  enough  as  a  result 
of  too  heavy  clothing  the  dull  and  sleepy  feeling  associated 
with  "bad  air"  results.  The  habit  of  wearing  too  many 
clothes  weakens  the  power  of  the  system  to  respond  quickly 
to  changes  in  temperature,  and  renders  one  susceptible  to 
colds.  Most  people  wear  too  heavy  underclothing  in  winter. 
Cotton  or  linen  underwear  is  generally  better  than  woolen; 
and  up  to  the  age  of  fifty  or  even  sixty  years  it  is  wiser  to 
wear  underclothing  of  the  same  weight  both  winter  and 
summer,  relying  on  an  overcoat  for  warmth  when  out  of 
doors  and  not  exercising. 

The  first  object  of  bathing  is  to  wash  off  the  dirt  and  soot 

,  which  soil  the  body  and  to  remove  the  waste 

^  ,^  „  ,,  .  materials  deposited   on  the   skin  by  per- 

Cold  Bathing  .    ^.         „^  ,     .,        .       •  j. 

spiration.     Warm  or  tepid  water  is  most 

effective  for  cleaning  the  hands  or  body.  Bathing  in  warm 
water  increases  the  size  of  the  blood  vessels  in  the  skin  and 
draws  the  blood  away  from  the  brain,  making  one  feel  com- 
fortably sleepy.  This  is  the  reason  why  a  warm  bath  is 
usually  taken  at  bedtime.  After  every  hot  bath  cold 
water  should  be  applied  to  the  entire  body.  A  cold  bath, 
on  the  other  hand,  contracts  the  skin  blood  vessels  and 
drives  the  blood  to  the  internal  organs  and  the  brain,  mak- 
ing one  feel  alert  and  keen.  Cold  bathing  is  a  powerful 
tonic  to  the  skin,  since  it  trains  these  blood  vessels  to  re- 
spond quickly  to  changes  in  temperature.  People  who  take 
cold  baths  regularly  are  likely  to  be  hardy  and  little  subject 
to  colds. 

20 


In  the  matter  of  bathing,  however,  we  must  again  re- 
member that  the  body  should  be  stimulated  a  '^  * 
by  cold  water,  but  not  chilled  too  severely.  _, 
A  cold  bath  should  be  followed  by  a  re- 
action ;  that  is,  the  surface  blood  vessels  should  enlarge  again, 
so  that  the  skin  becomes  warm  and  glowing.  Brisk  rubbing 
with  a  rough  towel  helps  to  secure  this  reaction.  If  no  re- 
action follows,  or  if  one  feels  tired  after  bathing,  the  bath  was 
too  cold  or  too  prolonged,  or  the  body  is  not  strong  enough 
to  endure  the  shock.  In  such  cases  cold  baths  may  do 
serious  harm. 

No  bath  of  any  kind  should  be  taken  within  an  hour  after 
eating.  The  blood  is  needed  in  the  intestines  for  the  process 
of  digestion,  and  it  is  harmful  to  disturb  the  circulation,  as 
any  bath  must  do  at  such  a  time. 

The  cleanliness  of  underclothing  is  of  specially  vital  im- 
portance to  the  soldier.     The  suppuration  ^        , 
of    wounds    is    frequently    due    to    germs  _, 
coming  from  dirty  clothing,  and  the  terrible 
disease  "trench-foot,"  which  has  afflicted  the  French  troops 
in  the  present  war,  has  been  shown  to  be  due  to  neglect  in 
this  regard.     Molds  from  damp  and  dirty  socks  get  into  cuts 
and  cracks  in  the  foot,  stop  up  blood  and  lymph  vessels, 
and  gangrene  follows  in  the  tissues  thus  deprived  of  the 
protective  action  of  the  body  fluids. 

Shoes  of  proper  shape  and  material  are  also  primary  mili- 
tary essentials.     Colonel  Keefer  says,  "No      Th    vf    '     ' 
one  article  of  the  soldier's  clothing  plays  so      „, 
large  a  part  in  his  efficiency  as  the  shoe." 

As  the  result  of  an  exhaustive  study  made  by  a  special 
army  board  created  to  study  this  subject,  the  problem  of 
army  shoes  has  been  satisfactorily  solved.  The  civilian, 
however,  still  often  suffers  from  improper  footgear.  The 
deformity  known  as  flat  foot,  often  accompanied  by  pains 
reaching  far  up  the  back,  may  be  caused  by  the  resulting 
strains.  A  hj-gienic  shoe  should  be  everywhere  as  wide 
21 


as  the  sole  of  the  foot,  and  wide  enough  in  front  to  permit  the 
toes  to  move  freely.  The  inner  edge  of  the  shoe  should  be 
straight,  so  that  a  line  drawn  back  from  the  middle  of  the 
great  toe  touches  the  heel.  The  heels  should  be  low  and 
broad.  The  sole  and  uppers  should  be  flexible,  so  that  the 
foot  may  be  bent  freely  at  the  point  where  the  toes  join  the 
instep.  A  high  shoe  should  not  be  so  tighth'  laced  at  the 
top  as  to  interfere  with  circulation.  A  porous  shoe,  like  one 
made  of  russet  leather,  is  much  better  than  an  enamel  or 
patent-leather  shoe,  because  it  allows  the  escape  of  moisture 
and  prevents  overheating  of  the  foot. 

CARE  OF  THE  TEETH  AND  BOWELS 

Many  obscure  maladies  of  the  joints,  the  heart  and  the 
kidneys  are  traced  to  bacterial  infections  arising  from  de- 
cayed teeth,  and  the  care  of  these  strong  but  delicate  struc- 
tures is  a  primary  essential  of  personal  hygiene. 

The  enamel  is  the  natural  protection  of  the  teeth,  and  it 

_,      _  f        i^  very  important  that  it  should  not  be  in- 

,     _,      ,  jured  by  cracking  hard  nuts  with  the  teeth 

or  picking  the  teeth  with  hard  objects  which 

might  splinter  them. 

On  the  other  hand,  thorough  chewing  of  the  food,  and 
particularly  of  fairly  hard  foods  like  crusty  bread,  helps  to 
polish  the  surfaces  of  the  teeth  and  to  prevent  deposits  on 
them.  The  coarse  food  which  savage  people  eat  helps  to 
keep  their  teeth  in  good  condition,  but  since  civilized  man 
eats  few  hard  foods,  especial  care  is  necessary  to  prevent 
tooth  decay  and  keep  the  mouth  healthy. 

The  most  important  help  in  keeping  the  teeth  in  good 
Th    T    tVi  condition  is,  of  course,  the  toothbrush.     It 

,       ,        J  has  been  said  that  in  an  army  the  soldier's 

J     ^j  toothbrush  should  be  inspected  every  morn- 

ing as  systematicall}''  as  his  gun.  The  teeth 
should  be  brushed  regularly  night  and  morning  at  least. 
22 


It  is  well  to  brush  them  after  each  meal,  because  the  sooner 
deposits  of  food  are  removed,  the  better.  Once  a  day  a  good 
tooth  powder  may  be  used  to  aid  in  cleaning  the  teeth.  For 
soldiers  in  the  field,  where  no  tooth  powder  is  available,  wood 
ashes  or  wood  charcoal  has  been  recommended. 

The  toothbrush  should  not  be  too  large,  and  the  bristles 
should  be  of  medium  hardness  and  so  shaped  that  they  will 
get  between  the  teeth.  Both  sides  and  the  top  of  the  teeth 
should  be  thoroughly  brushed.  It  is  much  better  to  brush 
do^Ti  or  up  from  the  gums  to  the  cutting  edge  than  side- 
ways across  the  teeth,  because  when  the  brush  passes  side- 
ways the  bristles  do  not  get  in  between  the  teeth.  The  most 
effective  method  is  to  place  the  bristles  of  the  brush  firmly 
against  the  teeth,  apply  pressure  as  if  trying  to  force  the 
bristles  between  the  teeth,  and  then  give  the  brush  a  rotary 
or  scrubbing  motion.  Care  should  be  taken  to  go  over 
both  the  back  and  the  front  of  the  cutting  teeth  in  both 
jaws,  as  well  as  the  flat  crowns  of  the  grinding  teeth.  The 
gums  above  and  below  the  teeth  and  the  surface  of  the 
tongue  should  also  be  cleaned. 

When  the  brushing  is  finished,  lukewami  water  should 

be  taken  into  the  mouth  and  forced  between     tn  ^  -i      r  ^y. 

and    around    the    teeth    several    times    by     «,    ^,  o^  .,  x 
»   ^,      ,.  ,     ,  ,    ^         ^      Tooth  Toilet 

means    of    the    lips,    cheeks,    and    tongue. 

This  is  as  important  as  the  proper  use  of  the  toothbrush 

itself.     The   tooth   toilet   should  take  from   three  to  five 

minutes. 

Even  the  best  use  of  the  toothbrush  will  not  always  keep 
the  spaces  between  the  teeth  entirely  clean.  If  food  par- 
ticles collect  in  these  spaces,  a  bit  of  dental  floss  may  be 
passed  up  and  down  between  the  teeth,  care  being  taken  not 
to  injure  the  delicate  gums. 

With  all  precautions  tooth  decay  is  likely  to  begin  in 
places;  and  the  teeth  should  be  regularly  examined  by  a 
competent  dentist  twice  a  year  to  detect  such  troubles  in 
time. 

23 


Another  common  cause  of  obscure  ailments,  headache, 

„      X    A     -J     dullness  and  feeling  of  oppression  is  decom- 
How  to  Avoid  ...         f  r     J  ,       •     .1      •   ,     . • 

p        .      .  position  of  food  wastes  in  the  intestines. 

If  the  bowels  are  not  emptied  regularlj^ 
bacteria  form  poisonous  products  of  decay,  which  are  ab- 
sorbed along  with  the  food  and  produce  far-reaching 
harmful  effects. 

It  is  important  to  form  the  habit  of  cleaning  out  the  in- 
testines regularly  at  least  once  a  day  and  perhaps  oftener, 
so  as  to  keep  the  intestinal  tube  clean.  If  this  does  not 
happen  naturally,  the  remedy  should  be  found,  not  in  medi- 
cines, but  in  drinking  plenty  of  water  and  eating  more  fruit, 
green  vegetables,  and  coarse  foods,  or  in  more  exercise,  sleep 
and  fresh  air. 

Too  frequent  loose  movements  of  the  bowels  (diarrhea) 
are  often  due  to  the  growth  of  special  kinds  of 
harmful  microbes  in  the  digestive  tract.  The 
best  remedy  is  cut  down  the  food,  particularly  meats  and 
eggs,  and  to  take  a  dose  of  castor  oil  or  some  other  medicine 
which  will  help  the  body  to  get  rid  of  both  microbes  and 
poisons.  If  the  trouble  continues,  a  doctor  should  be 
consulted. 


AVOIDANCE  OF  DRUGS  AND  STIMULANTS 

Among  the  influences  which  work  to  deprive  the  body 

of  its  maximum    efficiency,  none    is   more 

_j        f    T\  important   than   certain   dangerous   drugs, 

among  which  alcohol  is  the  chief  offender. 

Alcohol,  like  many  other  drugs,  acts  chiefly  on  the  nervous 

system;  it  does  not  serve  to  make  any  part  of  the  nervous 

system  work  more  readily,  but  numbs  or  puts  to  sleep  certain 

parts  of  it.     It  acts  first  of  all  on  the  inhibitions,  with  the 

result  that  some  of  the  nerve  actions  which  would  ordinarily 

be  inhibited  or  held  in  check  are  allowed  to  go  on  more  freely. 

This  seems  like  a  stimulation  or  increase  of  power,  but  it  is 

24 


really  only  a  breakdown  of  the  system  of  control.  The  situ- 
ation is  somewhat  similar  to  the  ease  of  a  runaway  hoi-se. 
The  horse  is  no  stronger,  but  is  much  more  dangerous, 
when  it  is  running  away  than  when  it  is  held  firmly  by  the 
reins  in  the  hands  of  a  skilled  driver. 
A  long  series  of  experiments,  of  which  the  most  recent 

have  been  carried  out  by  Prof.  F.  G.  Bene-         ai<,^i,^i  ««/i 
,     ^  •    TV'  ,  •,•      T   7       J  Alconol  and 

diet,  m  the  Carnegie  JSl  utrition  Laboratory,  Efficiency 
have  made  it  abundantly  clear  that  even 
very  moderate  doses  of  alcohol  tend  seriously  to  interfere 
with  the  working  of  the  nervous  machinery  of  the  body  and 
to  make  its  reactions  slow  and  clumsy.  Of  eleven  different 
tests  of  efficiency  made  by  Professor  Benedict,  all  but  two 
showed  a  decrease  in  quickness  or  accuracy  of  from  3  to  46  per 
cent,  in  the  persons  who  had  taken  alcohol.  The  relation  of 
the  use  of  alcoholic  liquors  to  industrial  accidents  is  well  rec- 
ognized; and  the  attitude  of  public  sendee  corporations  and 
other  large  employers  of  labor  toward  alcohol  offers  eloquent 
testimony  to  its  harmful  influence.  No  one  who  has  ever 
been  a  steady  user  of  alcohol  is  accepted  as  a  member  of  an 
arctic  expedition,  and  alcoholic  drinks  are  never  used  by 
those  engaged  in  these  enterprises.  Such  persons  have  been 
found  by  experience  to  be  lacking  both  in  efficiency  and  in 
the  ability  to  endure  the  necessary  hardships. 

Nor  are  the  results  of  the  use  of  alcoholic  liquors  limited 
to  a  temporary  interference  with  mental  and         . ,     ,    . 
physical  powers.     Exhaustive  studies  of  the  ,    , 

death  rate  among  abstainers  and  non-ab-  _  th  T?  t 
stainers  conducted  by  English  and  American 
life  insurance  companies  have  yielded  most  significant  results. 
One  such  recent  investigation  made  by  forty-three  American 
life  insurance  companies  showed  that  the  death  rate  of  those 
who  used  alcohol  steadily  and  freely  was  86  per  cent,  above 
the  normal,  while  the  rate  among  steady  moderate  drinkers 
(persons  taking  the  equivalent  of  two  glasses  of  beer  or 
one  glass  of  whiskey  a  day)  was  18  per  cent,  above  the  normal. 
25 


It  is  evident  that  alcohol  does  a  great  deal  of  harm  to 
certain  individuals  and  a  certain  amount  of  harm  to  all  who 
use  it  habitually.  No  man  who  wants  to  do  anything  diffi- 
cult, and  to  do  it  well,  uses  alcohol  beforehand.  No  sur- 
geon about  to  perform  a  difficult  operation  would  dream  of 
taking  a  drink.  No  athlete  would  think  of  drinking  before 
running  a  race.  When  a  person  wants  to  be  at  his  best,  to 
have  his  nerves  and  muscles  and  his  whole  body  working 
most  smoothly  and  effectively,  he  does  not  use  a  drug. 

So  it  is  with  nations.  The  evil  effects  of  alcoholic  drinks 
upon  national  efficiency,  and  the  wastefulness  involved,  were 
strikingly  recognized  in  the  European  War.  The  Russian 
government  stopped  the  sale  of  vodka  (the  Russian  strong 
drink),  and  the  governments  of  France  and  England  passed 
laws  to  restrict  drinking.  As  soon  as  the  European  nations 
wanted  to  be  at  their  best,  to  meet  a  great  crisis,  they  laid 
aside  the  burden  of  alcohol. 

Now  that  the  United  States  has  entered  the  world  con- 
flict the  policy  of  "down  glasses  till  the  war  is  over," 
should  be  the  slogan  of  every  man  determined  to  give  his 
country  his  best  service  in  an  hour  of  crisis. 

It  is  important  to  remember  that  both  alcohol  and  many 

_,,     p  other    harmful    and    often    habit-forming 

•Kjr  J'  '      T-  -1     drugs  are  often  taken  unknowingly  in  vari- 

Medicme  Evil  ,•    ,       .       ^    ^        j-  •  a  f 

ous  kinds  of  patent  medicmes.     Some  ot 

the  commonest  and  most  widely  advertised  "tonics"  and 
"spring  medicines"  owe  any  effect  they  have  to  the  fact 
that  they  are  composed  largely  of  whiskey.  Remedies  sup- 
posed to  cure  catarrh,  tuberculosis,  and  other  diseases  often 
contain  opiates  that  may  lead  to  a  drug  habit.  Medicines 
advertised  to  soothe  babies  usually  contain  morphine  or 
opium,  and  headache  cures  frequently  contain  deadly 
poisons,  such  as  acetanilid.  The  use  of  such  preparations, 
except  on  the  order  of  a  physician,  is  most  unwise.  Patent 
medicines  and  their  misleading  advertisements  do  immeasur- 
able harm  by  arousing  a  false  sense  of  confidence  and  de- 
26 


laying  the  medical  or  surgical  care,  prompt  use  of  which  is 
essential  in  such  diseases  as  cancer  and  tuberculosis.  The 
well  person  has  no  need  of  drugs  of  anj^  kind,  and  if  one  is 
ill  enough  to  need  drugs,  he  is  ill  enough  to  benefit  by  medical 
advice. 

HYGIENE  OF  ADULT  LIFE 

Statistics  show  that  at  ages  over  45  the  death  rate  in  the 

United  States  is  apparently  increasing  and   _.     -^     ^u 
J.   1  ■    J.I.  2.       ^^  The  Death 

not  decreasmg,  as  is  the  case  at  earher  age   ^  . 

periods.     The  increase  is  manifested  almost  _,  ^  ^ 

wholly  in  the  degenerative  diseases  of  the 

heart  and  blood  vessels  and  kidneys,  and  in  cancer.     Most 

of  the  degenerative  diseases  cannot  be  cured  in  the  sense 

that  diseases  of  early  life  are  cured.     Old  age  prevails  in 

time.     The  important  fact  is  that  in  too  many  cases  old 

age  comes  on  prematurely  and  without  the  victim  suspecting 

its  insidious  onset. 

The  premature  onset  of  old  age,  when  not  due  to  specific 
congenital  defects,  is  usually  the  result  of  _  - 

unhygienic   living  and  particular!}^  excesses  p 

of  various  kinds.     Under  the  unnatural  con-  _. ,  . 

ditions  of  modern  life  too  many  of  us  suffer 
from  too  little  air,  too  little  exercise,  too  much  work  and 
too  much  food. 

The   degenerative   diseases   of   adult   life   are   gradual  in 

their  onset  and  could  generally  be  checked  „  .        , 

if  the  enemy  were  detected  in  time.     When  •«,    ,•     ,  ^ 

disease  of  the  heart  or  arteries  or  kidneys        .     ^. 

,,  c    ^     ^    •     xu       J-  ammation  to 

or  any  other  organ  nrst  sets  in,  the  ordinary  _^  -^. 

rules  of  personal  hj^giene   must  be  supple-  .    -,. 
mented    by    special    rules    of    daily    living 
which  take  into  account  the  particular  defect.     Even  can- 
cer, one  of  the  most  deadly  of  the  diseases  of  adult  life,  can 
be  cured  in  a  large  proportion  of  cases  by  a  surgical  operation 
27 


if  the  condition  is  recognized  early  in  the  disease,  while  if 
treatment  is  delayed,  there  will  be  little  hope. 

The  only  way  in  which  these  physical  defects  can  be  de- 
tected early  enough  to  check  their  course  is  through  a  com- 
plete examination  of  the  whole  body  by  a  competent  phj^si- 
cian.  It  is  the  conviction  of  pubhc  health  authorities  that 
every  person  over  f ortj^-five  should  consult  a  physician  at  least 
once  a  year,  for  a  complete  examination  of  the  whole  body, 
to  learn  in  time  of  the  beginnings  of  disease  and  the  precautions 
necessary  to  prevent  it  from  extending.  Such  a  course  would, 
it  is  conservatively  estimated,  add  five  years  to  the  average 
life  of  persons  between  forty-five  and  fifty  years  of  age. 

MAN  AND  THE  MICROBE 

There  are  many  different  kinds  of  microbes  (or  little  living 
,  _    ,    things,  which  is  the  meaning  of  the  word), 
some  of  them  classified  by  the  biologist  as 
animals  and  some  as  plants.     Most  microbes 
are  harmless  and  some  are  actively  beneficial  to  man,  as,  for 
example,  the  bacteria  which  ripen  cream  and  make  vinegar 
and  those  which  fix  the  nitrogen  of  the  air  and  make  it  avail- 
able for  the  food  of  higher  plants.     A  few  of  the  microbes, 
however,  are  parasites  which  live  in  the  tissues  or  on  the 
surface  of  the  human  body  as  a  mold  grows  in  jelly.     As  the 
mold  forms  chemical  products  which  give  the  jelly  a  musty 
taste,  so  the  microbes  form  chemical  substances  called  toxins, 
which  poison  the  body  and  produce  the  symptoms  of  disease. 
Disease  germs  are  normally  propagated  only  by  transfer 

\iTu       -n-  from  one  human  being  (or  animal)  to  an- 

Wnere  Disease      .  rri,  •      r         x-  j. 

_,  _  other.     I  hey  may  survive  lor  a  time  out- 

_  side  the  body,  but  with  rare  exceptions  they 

do  not  multiply  under  such  conditions,  but 

gradually  and  progressively  perish.     In  an  experiment  by  the 

English  bacteriologist  Houston,  of  470,000  tjrphoid  germs 

placed  in  ordinary  tap  water,  only  480  were  alive  after  one 

28 


week,  31  after  two  weeks,  5  after  three  weeks,  and  none  after 
four  weeks.  The  danger  against  which  we  must  guard  is  the 
rather  direct  transfer  of  infectious  material  from  one  person 
to  another  (or  in  a  few  instances  from  one  of  the  higher 
animals,  such  as  the  cow,  to  man). 

The  source  of  disease  germs  is  then  the  human  (or  in  a  few 
cases,    the   animal)    bodJ^     An   important       „  ^ 

part  in  the  spread  of  communicable  disease  .  . 
is  played  by  early  cases  (not  yet  displaying 
any  characteristic  sjTnptoms  of  illness)  and 
by  ''carriers,"  persons  who  have  recovered  from  their  illness 
or  may  never  have  themselves  suffered  from  a  particular  dis- 
ease at  all,  and  yet  are  cultivating  in  their  bodies  and  spread- 
ing to  others  the  germs  which  are  capable  of  causing  the 
malady  in  question.  An  outbreak  of  over  three  hundred 
cases  of  typhoid  in  New  York  City  was  caused  by  a  milkman, 
a  typhoid  carrier,  who  had  had  typhoid  in  Michigan  forty- 
six  years  before  and  had  been  cultivating  the  germs  in  his 
body  ever  since.  One  or  two  out  of  a  hundred  well  persons 
in  a  given  community  may  be  cultivating  the  germ  of  diph- 
theria in  their  noses  or  throats,  and  one  or  two  out  of  a 
thousand  may  be  cultivating  the  germ  of  typhoid  fever  in 
gall  bladder  or  intestines.  In  such  diseases  as  pneumonia 
and  epidemic  cerebro-spinal  meningitis,  the  proportion  of  well 
carriers  may  be  much  higher,  and  infant  paralysis  appears  to 
be  chiefly  spread  in  this  manner. 

Bacteria  are  sohd  particles  not  easily  detached  from  moist 
surfaces.     Quietly  expired  air  is  germ-free,      „       -p.- 
and  disease  microbes  are  not  transmitted  by       _ 
the  atmosphere  except  where  there  is  gross       „         , 
local  pollution  by  the  spray  thrown  out  in         ^ 
coughing  or  sneezing  or  by  clouds  of  infected  dust.     Cloth- 
ing, books,  toys,  or  other  objects  handled  by  the  infected 
person  play  a  much  smaller  part  in  the  spread  of  disease 
than  was  thought  a  few  decades  ago.     There  is  no  absolute 
sharp  line  to  be  drawn  between  objects  of  this  sort,  which  are 
29 


dangerous,  and  those  which  are  not,  since  the  dying  out  of 
disease  germs  outside  the  body  is  a  gradual  one.  We  know, 
however,  that  the  danger  varies  inversely  with  the  time 
which  elapses,  and  that  the  legends  of  disease  caused  by 
toys,  locks  of  hair,  etc.,  put  away  for  months  and  years,  are 
almost  certainly  apocryphal. 

There  are  three  principal  vehicles  which  commonly  serve 
to  effect  a  rather  direct  transfer  of  infectious  material  from 
one  person  to  another,  and  which  between  them  account  for 
99  per  cent,  of  all  cases  of  communicable  disease.  These  are 
articles  of  food  and  drink,  flies  and  other  insects,  and  more 
or  less  direct  personal  contact — food,  flies,  and  fingers. 

DISPOSAL  OF  WASTES 

The  germs  of  disease  leave  the  infected  person  or  the 
-^  -  carrier,  in  most  instances,  in  the  body  dis- 

^  charges.     The  care  of  sputum  and  the  fine 

^  spray  thrown  out  in  coughing  or  sneezing  is 

essential  in  the  control  of  such  nose  and 
throat  diseases  as  tuberculosis,  diphtheria,  measles,  whoop- 
ing cough,  scarlet  fever,  septic  sore  throat,  and  the  like; 
while  in  the  control  of  the  bowel  diseases,  typhoid  fever, 
cholera,  hookworm  disease,  and  dysentery,  the  care  of  intes- 
tinal and  bladder  discharges  is  of  primary  importance. 
In  army  camps  and  in  all  unsewered  districts,  particularly 
. ,  ,  in  warm  climates,  the  proper  care  of  excre- 

^^  .  ment,  so  that  the  germs  it  contains  may  not 

be  carried  by  flies  or  in  other  ways  to  food, 
is  a  first  essential  of  sanitation. 

Typhoid  fever  earned  the  name,  "the  scourge  of  armies," 
on  account  of  the  epidemics  which  occurred  up  to  the  pres- 
ent century  whenever  large  bodies  of  men  were  brought 
together  without  adequate  precautions  in  regard  to  the  dis- 
posal of  bodily  wastes.  In  our  war  with  Spain,  we  had 
20,738  cases  of  typhoid  with  1,580  deaths  among  108,000 
men  in  a  period  of  less  than  four  months,  nine-tenths  of  all 
30 


deaths  among  the  troops  encamped  in  the  United  States 
being  due  to  this  cause. 

In  the  disposal  of  excrement  it  is  essential  to  avoid 
pollution  of  water  supplies,  and  above  all  _ 

the  exposure  of  the  wastes  in  such  a  manner  .^   . 

that  infection  may  be  carried  by  flies  or  in 
other  ways  to  food.  In  fixed  garrisons  satisfactory  methods 
of  disposal  will  usually  be  provided.  For  use  in  camp  good 
portable  incinerators  have  been  devised;  but  when  these 
are  not  available,  sink  or  latrine  trenches  may  be  dug  to 
receive  the  excreta,  in  such  a  position  as  not  to  menace  any 
source  of  water  supply.  In  fly  season  the  trenches  should 
be  provided  with  seats  with  the  lids  and  the  open  space  be- 
neath the  seats  boxed  in  or  covered  to  the  ground  with  mus- 
lin or  sacking.  When  it  is  impossible  to  prepare  pit  covers, 
crude  oil,  kerosene  or  chloride  of  lime  well  distributed  over 
the  sides  and  bottom  will  help  to  keep  flies  away. 

Indiscriminate  soil  pollution  is  a  military  offense  which 
may  be  of  serious  magnitude,  since  an  individual  in  perfectly 
normal  health  may  be  a  typhoid  caiTier  and  through  care- 
lessness may  infect  scores  of  his  fellows.  For  the  same 
reason  the  habit  of  washing  the  hands  after  resort  to  the 
toilet  is  of  the  greatest  importance. 

In  civil  life,  where  sewers  are  not  available,  the  provision 
of  tightly  built  fly-proof  outside  toilets  is  _.  .    , 

of  vital  sanitary  importance.     The  screen-  __        ... 

ing  of  such  closets  in  Jacksonville,  Fla.,  _.. 
and  elsewhere  has  been  followed  by  phenom- 
enal decreases  in  the  typhoid  death  rate.  For  thickly 
settled  communities  the  installation  of  a  sewerage  system 
of  course  offers  the  ideal  solution  of  the  difficulty  from  the 
standpoint  of  the  individual  householder.  The  sewage 
collected  by  such  a  system  may  be  so  treated  as  to  be  purified 
to  any  desired  degree  by  screening,  sedimentation,  filtration 
or  disinfection  before  it  is  discharged  into  adjacent  water- 
courses. 

31 


INSECTS  AND  DISEASE 

Insects  were  in  the  past  a  far  more  important  factor  in 

p.  ,  the  spread  of  disease  than  is  the  case  today. 

_, ,      ,T>.  Bubonic  plague,  which  destroj-ed  a  quarter 

Olden  Times        «  ^,  f^-        c  t?  •    ^u    a/t-jji 

of  the  population  of  Europe  in  the  Middle 

Ages,  is  primarily  a  disease  of  the  rat,  spread  from  rat  to  rat, 
and  from  rat  to  man  by  the  bite  of  the  flea.  The  dreaded 
typhus  fever,  which  once  decimated  jails  and  camps,  is 
spread  by  the  bite  of  the  body  louse.  With  improvements 
in  habits  of  personal  cleanliness  these  pestilences  have  dis- 
appeared from  civilized  countries.  Plague  broke  out  in 
1894,  ravaged  India,  and  found  its  way  to  ports  all  over 
the  knowTi  world,  but  nowhere  outside  of  Asia  could  it  gain 
a  foothold.  T^-phus  was  almost  forgotten  until  the  con- 
fusion and  ruin  of  the  European  War  permitted  its  appear- 
ance on  the  Eastern  battle  front.  It  is  controlled  by  de- 
stro^dng  lice  through  rigid  measures  of  disinfection  of  the 
bodies  and  clothing  of  those  who  have  been  exposed  to 
infection. 

The  most  important  insect  carriers  of  disease  todaj^,  out- 
_,  side  of  certain  regions  in  Africa,  are  the  fly 

_..  ,     _  and  the  mosquito.     The  common  house  fly 

or  filth  fly  is  only  an  accidental  carrier  of 
such  disease  germs  as  it  may  happen  to  pick  up  on  its  feet 
or  body;  but  in  warm  climates,  where  excreta  are  improperly 
disposed  of,  it  is  an  important  factor  in  the  spread  of  t ji^hoid 
fever,  and  studies  in  New  York  City  and  Richmond,  Va., 
have  showTi  that  it  may  play  a  considerable  role  in  distribut- 
ing the  genus  of  infant  diarrhea.  The  first  essential  in  con- 
trolling the  fly  is  to  do  away  with  its  breeding  places  by 
proper  care  of  stable  manure,  in  which  it  lays  its  eggs  by 
preference,  and  by  the  elimination  of  other  decaying  rub- 
bish. Manure  should  be  stored  in  a  closed  dark  bin  with 
an  impervious  floor  and  removed  once  a  week.  The  tight 
floor  and  complete  removal  are  essential,  since  the  fly  mag- 
32 


got  burrows  down  into  the  ground  or  out  into  the  outer  drier 

portions  of  the  manure  to  go  into  its  resting  or  pupa  stage, 

before   it   hatches  out  as  an  adult   fly.     Fly   maggots  in 

manure  may  be  destroyed  bj^  the  use  of  borax  or  hellebore. 

x\dult  flies  may  be  trapped  or  poisoned.     The  traps  most 

commonly  used  consist  of  a  wire  cone  in  a     -^,    ^  , 

box  or  cage  largely  of  wire,  with  bait  under     ^,    „  . 
.      .        *,       ^   *       .         '      ,  „       Fly  Poisons 

the  large  lower  openmg  of  the  cone.     On 

leaving  their  food  the  flies  go  upward  toward  the  light, 
through  the  small  opening,  and  into  the  cage,  in  which  they 
perish.  For  fly  poisons  the  U.  S.  PubHc  Health  Service 
recommends  formaldehyde  or  sodium  salicylate.  For  house- 
hold use  these  solutions  may  be  prepared  by  the  addition  of 
three  teaspoonfuls  of  either  the  40  per  cent,  solution  of 
formaldehj^de  found  on  the  market  or  the  powdered  sodium 
salicylate  to  a  pint  of  water.  Nearly  fill  a  glass  tumbler 
with  the  solution,  place  over  this  a  piece  of  blotting  paper 
cut  to  a  circular  form  and  somewhat  larger  in  diameter  than 
the  tumbler,  and  over  this  invert  a  saucer.  Invert  the 
whole  device  and  insert  a  match  or  toothpick  under  the 
edge  of  the  tumbler,  to  allow  access  of  air.  The  blotting 
paper  will  remain  in  the  proper  moist  condition  until  the 
entire  contents  of  the  tumbler  have  been  used  and  the 
strength  of  the  formaldehj^de  solution  will  be  maintained. 
A  little  sugar  sprinkled  upon  the  paper  will  increase  the 
attractiveness  of  the  poison  for  the  flies. 

The  conquest  of  mosquito-borne  disease  is  one  of  the  most 
brilliant  triumphs  of  sanitation.     The  fact    rp,      p 
that    yellow    fever,    the    curse    of    tropical       r  y  11 

America,   was  transmitted   by  the   bite  of     _ 

Fever 
the  ^des   mosquito  was  demonstrated  by 

Major  Walter  Reed  and  three  other  surgeons  of  the  U.  S. 
Army  in  1901,  by  experiments  on  themselves  and  other 
volunteers,  Jesse  W.  Lazear,  one  of  the  intrepid  investi- 
gators, giving  his  life  for  the  cause.  As  a  result  of  this  dis- 
covery the  pestilence  which  had  caused  750  deaths  a  year  in 
33 


the  City  of  Havana  alone  was  wiped  out  in  a  few  months, 
the  building  of  the  Panama  Canal  was  made  possible,  and 
tropical  America  was  rendered  habitable  for  the  white  race. 

Malaria,  our  principal  insect-borne  disease,  is  held  re- 
^         .  sponsible    for    an    annual    money    loss    of 

d^M  1  ^^  $100,000,000  in  the  United  States  alone. 
It  is  transmitted  by  the  bite  of  the  Anopheles 
mosquito,  which  breeds  in  pools  of  stagnant  water  and  woody 
sluggish  streams.  The  adult  mosquito  of  this  type  can  be 
distinguished  from  the  common  or  Culex  mosquito  by  the 
fact  that  its  wings  are  spotted  and  by  its  posture  when 
lighted.  Its  body  stands  out  in  a  straight  line  at  an  angle 
to  the  surface  on  which  it  rests,  while  the  body  of  the  com- 
mon mosquito  stands  in  a  humpbacked  position,  with  the 
posterior  part  of  its  body  roughly  parallel  to  the  wall  or 
ceiling. 

The  control  of  malaria  depends  on  the  elimination  of 
breeding  places  by  drainage  of  swamps,  by  cutting  out  and 
clearing  ditches,  streams  and  pools,  and  by  the  elimination 
of  small  receptacles  of  stagnant  water.  Mosquito  larvae, 
or  "wigglers,"  may  be  destroyed  by  the  use  of  oil  or  poison- 
ous larvicides  or  by  stocking  ponds  with  fish,  which  feed  upon 
them.  Adult  mosquitoes  should  be  kept  out  of  houses,  and 
particularly  excluded  from  malaria  patients  by  screening, 
and  in  seriously  infected  regions,  quinine  should  be  system- 
atically employed  as  a  prophylactic. 

SPREAD  OF  DISEASE  BY  CONTACT 

While  the  diseases  carried  by  food  and  by  insects  have  in 
_     .     .  ■.  large  measure  been  brought  under  control, 

'  the  diseases  which   are  chiefly  spread   by 

contact,  particularly  such  diseases  as  diph- 
theria, measles,  scarlet  fever  and  whooping  cough,  which  are 
disseminated  by  the  discharges  from  the  nose  and  throat, 
have  been  much  less  successfully  controlled.     The  methods 
34 


by  which  infection  finds  its  way  from  one  mouth  to  another 
are  almost  without  number.  The  common  ch'inking  cup 
and  the  direct  discharge  of  mouth  spray  in  coughing  or 
sneezing  furnish  two  obvious  modes  of  infection.  A  hun- 
dred times  a  day  fingers  and  other  things  that  are  not  bac- 
teriologically  clean  go  to  the  mouth  or  nose,  and  to  one  who 
considers  the  possibiUties  the  wonder  is,  not  that  we  contract 
diseases,  but  rather  that  we  so  often  fail  to  do  so. 

The  only  reliable  defense  against  contact  disease  is  the 
cultivation  of  habits  of  personal  cleanHness  that  will  keep 
everything  but  food  and  the  toothbrush  away  from  the 
mouth,  and  that  will  make  the  thorough  washing  of  the  hands 
before  handling  food  an  absolute  and  inevitable  routine. 

In  all  communicable  diseases,  but  particularly  in  those 

which  are  spread  by  contact,  it  is  important    j    i  ^.        f 

to  surround  all  known  infected  persons  with    _  .     ,  , 

,         ,  „       Communicable 

special  precautions,  so  as  to  reduce  as  tar    _. 

as   possible   the   danger   of   the   spread   of 

disease  germs  from  them.     For  this  reason  the  reporting  of 

communicable  diseases  to  the  health  authorities  is  required 

by  law,  and  boards  of  health  maintain  special  laboratories 

to  assist  in  the  early  diagnosis  of  suspicious  cases  of  disease. 

When  the  infected  person  is  found  he  must  be  isolated  or 

cared  for  under  such  conditions  that  family  and  friends  will 

not  be  endangered;  and  if  this  cannot  be  done  at  home,  he 

must  be  removed  to  an  isolation  hospital. 

In  isolation  emphasis  is  laid  particularly  upon  limiting 

direct  contact  with  the  patient  to  the  nurse  or  person  in 

immediate  charge,  upon  the  prompt  disinfection  of  body 

discharges  and  clothing,  bedding,  etc.,  soiled  with  discharges, 

and  upon  the  disinfection  of  objects  which  leave  the  sick 

room,  and  particularly  of  the  hands  of  the  attendant.     If 

such  precautions  are  not  conscientiously  observed  during  the 

course  of  the  disease,  fumigation  at  its  close  will  be  of  little 

use,  since  susceptible  persons  in  the  house  will  already  have 

been  infected.     If  isolation  has  been  thorough,  terminal  fumi- 

35 


gation  is  unnecessary,  since  there  will  be  no  gro?s  soiling  of 
the  sick  room  with  discharges,  and  occasional  germs  coughed 
out  onto  the  floor  or  wall  will  soon  die  out  and  disappear. 

Each  communicable  disease  has  its  own  definite  period  of 
„  ,  ^.  ,  duration,  and  experience  teaches  that  a  cer- 
P  1  «;h  IH  ^^^^  number  of  days  or  weeks  must  pass  be- 
_  T  1  f  J  foJ*6  i^  is  safe  for  the  patient  to  mingle  with 
other  people.  The  periods  of  isolation  for 
the  more  common  communicable  diseases  are  shown  in  the 
following  table.  In  each  case,  of  course,  the  patient  should 
be  isolated  until  he  has  entirely  recovered  from  the  disease, 
and  running  of  the  nose  and  ears  has  ceased.  In  diphtheria 
the  only  safe  rule  is  to  wait  until  tests  made  by  a  bacteriolo- 
gist show  that  the  nose  and  throat  are  free  from  diphtheria 
germs. 

Isolation  Periods  of  Common  Commtjnicable  Diseases 

.  Isolation  Period  from  Time 

of  Beginning  of  Attack 

Chickenpox 12  days 

German  measles 8  days 

Measles 10  days 

Mumps 2  weeks 

Scarlet  fever 30  days 

Whooping  cough 8  weeks,  or  until  one  week 

after  last  whoop 

The  fact  that  many  diseases  are  particularly  catching  just 
^  ,  when  they  are  beginning  makes  it  very  im- 

^  portant  to  watch  for  the  onset  of  disease 

,  ^ .        ^  and  to  start  isolation  as  soon  as  possible. 

or  13lS63.S6 

Measles,  for  instance,  begins  like  an  ordi- 
nary cold  in  the  head,  with  sneezing  and  running  nose  and 
eyes.  It  has  been  shown  by  the  investigations  of  Anderson 
that  there  is  far  more  danger  of  spreading  the  germs  of 
measles  at  this  time  than  there  is  later,  when  a  rash  has 
appeared  and  the  patient  has  been  put  to  bed. 
36 


Children  should  never  be  sent  to  school  and  should  not 
play  with  other  children  when  they  have  any  of  the  signs 
which  may  mean  an  attack  of  communicable  disease,  par- 
ticularly if  there  is  reason  to  think  they  may  have  been 
exposed  to  infection. 

The  principal  signs  of  the  beginning  of  an  attack  of  com- 
municable disease  are  the  following: 

Coughing,  Watery  eyes, 

Sneezing,  Headache, 

Running  nose,  Vomiting, 

Sore  throat,  Diarrhea, 

Feverishness,  Swelling  or  pain  back 
Rash  or  spots  of  any  kind,  of  or  under  the  ears. 
Weak,  tired  feeling, 

In  each  particular  disease  a  certain  time  must  elapse 
between  the  day  when  a  person  first  gets  the  .       ,     , 

germ  into  his  body  and  the  day  when  the  p    •  h    ' 

actual  symptoms  of  disease  appear.     This  is  _ 

called  the  period  of  incubation.   During  this  ^. 

J_JlS63SGS 

time  the  germs  are  growing  in  the  body  until 
there  are  enough  of  them  to  make  the  person  feel  sick.     The 
incubation  period  varies  with  different  diseases,  from  a  few 
days  to  several  weeks.     The  periods  for  the  commoner  dis- 
eases are  shown  in  the  table  below. 

Disease  Incubation  Period 

Chickenpox 11-22  days 

German  measles 1 1-22  days 

Measles 8-15  days 

Mumps 15-22  days 

Scarlet  fever 7  days 

Whooping  cough 14  days 

Those  who  have  been  exposed  to  any  of  the  communicable 
diseases  should  be  kept  under  observation,  and  if  possi*ble 
37 


isolated  from  others  until  the  period  of  incubation  has  passed 
without  any  signs  of  the  disease  appearing.  In  the  case  of 
chickenpox,  German  measles,  measles,  mumps  or  whooping 
cough,  this  is  not  necessary  if  the  person  has  had  the  disease 
before,  and  is,  therefore,  immune.  In  diphtheria  the  incu- 
bation period  is  short  (from  one  to  five  days),  but  carrier 
cases  are  so  common  that  all  those  who  have  been  exposed  to 
diphtheria  should  have  their  throats  examined  and  a  sample 
taken  from  the  throat  for  bacteriological  examination. 

Everyone  takes  typhoid  and  scarlet  fever  seriously,  but 
_  ,     measles  and  whooping  cough  are  often  re- 

__      ,  ,       garded  as  unimportant  and  negligible  in- 

Measlesand      f   ^.  a.,  ••     u  1 

_-_        .  fections.     This  is  by  no  means  the  case. 

_       u  Measles    is    an    important    cause    of     in- 

validism in  the  army.  "  In  the  Union  Army 
during  the  Civil  War,  there  were  76,000  cases  with  more  than 
5,000  deaths.  Among  the  Confederates  whole  brigades  were 
temporarily  disbanded  on  this  account  in  the  early  part  of 
the  war."  Among  the  civil  population  measles  is  in  most 
cities  the  cause  of  more  deaths  than  either  typhoid  or  scarlet 
fever,  while  whooping  cough  stands  very  close  to  it.  Above 
all  it  should  be  remembered  it  is  to  young  babies  that  these 
maladies  are  most  deadly.  Measles  and  whooping  cough 
are  more  than  five  times  as  fatal  in  infants  under  one  year 
of  age  as  in  children  over  five.  Every  possible  effort  should 
therefore  be  made  to  protect  infants  from  contact  with  those 
who  have  any  symptoms  of  what  may  prove  an  infectious 
disease. 

IMMUNITY  AND  ITS  CONTROL 

Every  attack  of  communicable  disease  is  a  struggle  be- 
^.    .  tween  the  invading  microbes  and  the  body, 

_     .  for  as  soon  as  foreign  germs  enter,  the  sol- 

dier cells  of  the  blood  attack  the  invaders 
while  the  tissues  of  the  body  begin  to  produce  chemical  sub- 
38 


stances  which  tend  to  destroy  the  germs  or  neutralize  their 
poisons.  The  degree  of  this  natural  vital  resistance  varies 
widely.  Disease  germs,  like  other  enemies,  are  more  likely 
to  attack  weak  people  than  strong  ones,  though  some  dis- 
eases, like  measles  and  smallpox,  affect  all  alike. 

Besides  this  sort  of  general  vital  resistance,  a  person  who 

has  recovered  from  an  attack  of  some  spe-  _  .^ 

.^  •    1  1     T  .  •  ,  Immunity 

ciric  communicable  disease  enjoys  a  special  .     .     ^  o      -^ 
.,  •    X   -1  -  •    1  •    Agamst  Specific 

immunity  agamst  the  particular  germ   in     ° 

question  as  a  result  of  the  struggle  through 
which  it  has  passed.  In  a  number  of  diseases  it  is  now  pos- 
sible to  produce  at  will  a  state  of  immunity  by  the  introduc- 
tion into  the  body  of  weakened  or  killed  cultures  of  the  germ 
which  have  lost  the  power  to  produce  active  disease,  but 
are  still  able  to  stimulate  the  tissues  of  the  body,  so  that  they 
can  defend  themselves  against  a  later  attack  of  living  and 
virulent  microbes. 

This  principle  was  applied  over  a  century  ago  in  the  case 
of  smallpox  by  Edward  Jenner,  an  English         „      .. 

physician.    It  has  been  said  that  this  dis-         ,^      .     ^. 

V  ^ccixi^Liori 
covery  of  vaccination  by  Jenner  was  the 

greatest  single  practical  benefit  ever  bestowed  by  one  man 
upon  the  human  race.  As  soon  as  vaccination  was  generally 
introduced,  the  dreaded  epidemics  of  smallpox  ceased,  and 
this  disease  now  exists  only  as  far  as  vaccination  is  neglected. 
During  the  eight  years  before  the  American  Army  entered 
Havana,  there  were  3,132  deaths  from  smallpox  in  the  city; 
during  the  next  eight  years,  when  vaccination  was  enforced, 
there  were  seven. 

Vaccination  has  conquered  smallpox  so  successfully  that 
people  have  almost  forgotten  what  a  terrible  disease  it  was, 
and  some  of  them  have  grown  careless  about  vaccination. 
Others  object  to  being  vaccinated  for  fear  some  infection 
may  get  into  the  wound.  All  vaccine  used  in  the  United 
States  is  now  tested  as  to  its  purity  by  the  National  Gov- 
ernment, and  there  is  no  danger  from  its  use,  provided  that 
39 


the  place  where  the  vaccine  is  rubbed  into  the   arm   or  leg 

is  kept  clean  and  free  from  dirt  germs.     The  protective 

effect  of  vaccination  wears  off  after  a  time.     Every  child 

should,  therefore,  be  vaccinated  when  about  a  year  old,  and 

again  at  about  the  seventh  year. 

The  most  brilliant  practical  application  of  the  principle 

.    ,.  ^     ,    ,,       of  vaccine  therapy,  since  the  time  of  Jenner, 
Anti-Typhoid      ,        .  ^u  ^-         c  ^u 

,     *;.  has   been   the  preparation   ot   the  vaccme 

now  used  for  the  prevention  of  typhoid  fever. 

Its  adoption  in  the  United  States  Army  has  been  attended 

with  brilliant  results,  as  indicated  by  the  table  below. 

Cases  of  Typhoid       Typhoid  Deaths 
Year       Vaccination 


Nu-ber    RJ|^«  Number   ^f^' 


1907  None 237  3.79  19  .30 

1908  None 239  3.20  24  .31 

1909  Voluntary 282  3 .35  22  .26 

1910  Voluntary 198  2 .43  14  .17 

1911  Voluntary 70  .85  8  .10 

1912  Compulsory 27  .31  4  .04 

1913  Compulsory 3  .03  0  .00 

Mixed  vaccines  which  will  protect  against  typhoid  fever 

and  the  two  distinct  forms    of    a  similar 

.„.    ,  disease,  paratyphoid  fever,  have  been  used 

the  Allied  .^,    ^^  -i  •  ■    ^.u    -c^ 

with  striking  success  in  the  European  armies 

during  the  present  war.  The  number  of 
cases  of  typhoid  fever  among  British  troops  in  France  up 
to  November  1,  1916,  was  1,684,  of  paratyphoid  cases,  2,534, 
and  of  indefinite  related  fevers,  353,  a  total  of  4,571.  In  the 
South  African  War  nearly  60,000  cases  of  typhoid  f eve  r  alone 
were  admitted  into  hospital,  and  there  were  8,227  deaths. 

Armies  in  the  past  have  been  an  important  agent  in  spread- 
ing typhoid  and  other  infections  through  the  regions  where 
they  operated  and  in  the  homes  to  which  they  returned. 
Today  the  success  of  typhoid  vaccination  in  our  military 
establishments  points  the  way  to  the  elimination  of  this 
40 


disease  in   civil   life.     Every  man   and  woman   under  45 

should  make  use  of  this  simple  and  efficient  safeguard. 

Another  method  of  controlling  immunity  is  by  the  use  of 

antitoxins,   or  antitoxic  sera,   as  they  are    n^.    tt        r 

,,    ,      ,.     ,  •  ,     ,•  1  .1     •        /-^  The  Use  of 

often  called,  of  which  diphtheria  antitoxin      ....     .    _ 

,     ,  ,  Antitoxic  Sera 

is  the  best  example. 

Diphtheria  antitoxin  was  introduced  into  the  United  States 
by  the  New  York  City  Department  of  Health  in  1894,  and 
it  has  reduced  the  death  rate  from  diphtheria  in  that  city 
from  155  deaths  for  every  hundred  thousand  of  the  popula- 
tion, to  24.  The  antitoxin  is  of  comparatively  little  value 
when  the  attack  has  gone  on  for  a  long  while  and  the  body 
has  become  severely  poisoned,  but  if  it  is  used  as  soon  as  the 
disease  begins,  it  is  a  practically  certain  cure. 

Antitoxic  sera  are  also  used  in  the  treatment  of  tetanus, 
meningitis  and  more  recently  in  certain  forms  of  pneumonia. 

From  a  mihtary  standpoint  some  of  the  most  important 
appHcations  of  the  principles  of  vaccine  and  r     tr  1    f 

serum  therapy  are  those  which  have  been  _..        , 

worked  out  in  connection  with  the  treat-  iff 

ment  of  wound  infections.  The  surgeon  in 
his  operating  room  relies  on  antiseptic  and  aseptic  methods 
to  keep  out  the  germs  of  suppuration.  Wounds  received  in 
battle  are  generally  already  infected  and  the  destruction  of 
germ  life  is  impossible  without  serious  injury  to  the  tissues 
themselves.  The  military  surgeon  must  therefore  rely 
largely  on  the  stimulation  of  the  defensive  machinery  of  the 
body  (except  in  the  case  of  tetanus,  for  which  a  specific  and 
powerful  antitoxin  is  at  his  disposal).  The  newer  solutions 
used  in  the  treatment  of  wounds,  such  as  Dakin's  chloramine, 
are  specially  adapted  to  check  bacterial  growth  without 
harming  the  soldier  cells  of  the  blood;  and  the  use  of  a  strong 
salt  solution  for  the  treatment  of  an  infected  wound  pro- 
duces an  increased  flow  of  lymph  from  the  tissues  into  the 
wound,  thus  relieving  the  inflamed  tissues  of  congestion  and 
setting  up  a  flow  of  fluid  from  within  outwards,  which  tends 
41 


The  Great 
White  Plague 


to  wash  away  bacteria.  Both  the  lymph  and  the  strong 
salt  solution  are  unfavorable  to  the  gro\vth  of  bacteria.  So 
far  as  the  white  corpuscles  are  concerned,  strong  saline  solu- 
tions are  unfavorable  to  their  vitalitj^;  but  when  the  wound 
has  become  healthier,  it  is  usual  to  decrease  the  strength  of 
the  salt  solution  until  its  saturation  has  reached  that  of  a 
fluid  of  the  same  specific  gravity  as  the  blood.  In  a  fluid 
of  this  degree  of  concentration  the  body  cells  can  hve  and 
act  freely. 

TUBERCULOSIS 

Tuberculosis,  a  disease  which  causes  about  one-third  of 
all  the  deaths  which  occur  between  the 
ages  of  18  and  45,  and  kills  each  year  about 
150,000  people  in  the  United  States,  is 
caused  by  a  bacterium  which  may  grow  in  a  great  many 
different  parts  of  the  body,  although  it  is  most  likely  to  be 
found  in  the  lungs,  causing  tuberculosis  of  the  lungs,  or 
consumption.  The  germ  does  not  grow  all  through  the 
lungs  in  this  disease,  but  here  and  there  at  special  points, 
where  there  form  hard  little  knots  or  tubercles,  from  which 
the  disease  is  named. 

Tuberculosis  of  the  bones  is  not  uncommon  among  children, 
and  a  great  many  of  the  lame  people  we  see  on  the  streets 
are  crippled  from  this  cause. 

The  primary  cause  of  tuberculosis  is  a  germ  discharged  in 
-,,      _  ,      the  spray  and  sputum  coughed  out  by  con- 

-,  ,  .  .  sumptives,  and  infection  comes  in  most 
cases  from  getting  these  human  discharges 
into  the  mouth.  Sometimes  the  germ  is  inhaled  in  dust, 
but  it  is  more  frequently  transferred  from  one  person  to 
another  by  rather  direct  contact. 

A  great  many  cattle  suffer  from  tuberculosis,  and  children 
may  become  infected  by  drinking  the  milk  of  tuberculous 
cows. 

42 


To  prevent  the  spread  of  tuberculosis  it  is  necessary  first 

of    all    to    destroy    the    germs    discharged  „  _ 

from    the    mouths    of    consumptives;    and  ...     o         j 

,    ,           .      •  -.          11      f     n  vent  the  Spread 

second,  to  pasteurize  the  milk  of  all  cows  ,  _,  ,          ,     . 

,        ,  .  ,     ,  X     t      f       r         ^i  of  Tuberculosis 

not  certainlv   known  to   be   free  from  the  _  ,    ,. 

J.                  ^                                     -  Infection 
disease. 

The  careless  consumptive  is  a  great  danger  to  his  family 
and  associates,  but  one  who  is  always  careful  to  destroy  his 
sputum  and  to  avoid  coughing  out  mouth  spray  into  the  air 
need  not  be  a  menace  to  the  health  and  life  of  others.  The 
consumptive  should  always  cough  into  a  cloth  or  handker- 
chief, or  a  paper  napkin,  which  can  be  burned,  and  all  sputum 
should  be  received  in  paper  cups  and  burned  at  the  end  of  the 
day.  If  handkerchiefs  are  used,  they  should  not  be  put  into  a 
laundry  bag  or  basket  with  other  soiled  linen,  but  should  be 
boiled  for  twenty  minutes  in  a  strong  soapsuds  solution. 

Tuberculosis  is  a  disease  in  which  vital  resistance  plays  a 

specially  important  part.     The  germ  is  un-       v"f  1  P     * 

fortunately  very  common;  in  fact,  almost    .  . 

every  individual,  sooner  or  later,  is  slightly      ^  ,         ,     . 
■  f    .    1     uu  -^  Tuberculosis 

iniected  with  it. 

This  does  not  mean  that  ever}^  man  has  tuberculosis,  in 
the  sense  of  suffering  from  actual  disease.  The  human  body 
has  a  wonderful  power  of  defending  itself  against  this  in- 
vader, and  a  few  germs  entering  a  healthy  body  are  quickly 
overcome.  It  is  when  a  great  many  germs  are  taken  in,  and 
particularly  when  the  strength  is  reduced  b}^  attacks  of  other 
diseases,  or  when  resistance  is  lowered  by  intemperate  habits, 
by  living  and  working  in  overheated  rooms,  by  eating  insuf- 
ficient food,  or  by  breathing  sharp  dust  particles,  that  the 
invisible  enemy  overcomes  the  defenses  of  the  body.  France 
has  today  some  500,000  cases  of  tuberculosis  to  care  for 
because  of  the  deadly  effects  of  the  strain  of  trench  life 
upon  soldiers  who,  in  a  time  of  crisis,  had  to  be  sent  to 
the  front  whether  they  were  in  full  physical  health  or 
not. 

43 


People  who  have  recovered  from  tuberculosis,  and  those  in 

J  whose  family  there  has  been  a  case,  should 

^  ,  ,  .  be  specially  on  guard  aeainst  allowing  their 
Tuberculosis         -^  ,      •  /       ^   u  i       j     a 

vital  resistance  to  become  weakened.  Among 

the  most  important  causes  of  tuberculosis  are  the  unsanitary 
conditions  of  factory  life.  An  overheated,  unventilated 
workshop  is  certain  to  lower  vital  resistance  and  make  the 
worker  an  easy  prey  to  the  tuberculosis  germ,  particularly  if 
he  is  weakened  by  long  hours  of  labor.  An  especially  dan- 
gerous thing  about  some  industries  is  the  fact  that  the  air  of 
the  workshops  is  full  of  fine  particles  of  mineral  or  metallic 
dust.  These  dust  particles  are  inhaled  and  injure  the  deli- 
cate tissues  of  the  lung,  so  that  tuberculosis  germs  find  it 
easy  to  grow  there.  The  workers  in  some  of  these  industries 
— granite  workers  and  grinders,  for  instance — are  two  or 
three  times  as  likely  to  contract  tuberculosis  as  are  people 
who  work  at  less  dangerous  trades. 

In  all  such  places  there  should  be  special  pipes  with  exhaust 
fans  to  draw  off  the  dust  from  the  air.  Where  this  cannot  be 
done,  the  worker  should  wear  a  respirator  over  his  mouth,  to 
keep  out  the  dust  particles. 

Just  as  the  tuberculosis  germ  fails  to  gain  a  real  foothold 

in  the  body  of  a  thoroughly  healthy  person, 

^  ,  ,  .  so  by  proper  hygienic  treatment  it  can  be 
Tuberculosis  ■,  r^     •.  u     u  v         i 

conquered  even  after  it  has  begun  its  work. 

There  are  no  medicines,  in  the  ordinary  sense,  that  will 
cure  tuberculosis.  All  so-called  "Consumption  Cures"  are 
frauds  which  take  the  money  of  their  victims  and  do  them 
immeasurable  harm  by  wasting  precious  time.  The  cure  for 
tuberculosis  is  hygienic  living  under  the  advice  of  a  compe- 
tent physician,  properly  directed  rest  and  exercise,  plenty  of 
fresh  air,  and  a  sufficient  amount  of  wholesome  food.  If 
such  treatment  is  taken  early  in  the  disease,  tuberculosis  can 
generally  be  cured. 

The  main  thing  is  to  begin  the  treatment  of  tuberculosis  as 
soon  as  possible.  The  time  to  put  out  a  fire,  or  to  control 
44 


a  disease,  is  before  it  gets  well  under  way.     When  tuberculosis 

has  gone  far,  it  cannot  usuall}^  be  checked,      t        ^t  f 

but  if  the  disease  is  attacked  at  its  beginning,  ^ 

there  is  every  reason  to  be  hopeful.     Among      ^     \_      ^ 
^     ,  .      ,  ,1     Treatment 

the    common    danger    signals    are    loss   oi 

weight,  loss  of  appetite,  prolonged  ''cold"  with  cough  and 
spitting — the  expectorations  sometimes  blood-tinged — fre- 
quent hoarseness,  afternoon  fever,  chills,  nightsweats,  easy 
tiring,  and  pains  in  the  chest.  One  of  the  earliest  symptoms 
of  pulmonarj^  tuberculosis  is  a  sense  of  weakness  and  loss  of 
energy,  both  of  body  and  mind,  not  infrequently  out  of  all 
proportion  to  the  extent  of  the  disease.  If  any  of  these 
symptoms  are  present,  the  patient  should  go  to  a  physician 
and  have  his  lungs  examined. 


RACIAL  HEALTH 

Success  in  the  struggle  for  existence  involves 

Individual  efficiency 

Perpetuation  of  the  Race 

Both  personal  health  and  success  in  leaving  progeny  are 
threatened    by    the    grave    communicable      _.     __ 
maladies  which  are  known  as  the  venereal        ,  _.  . 

diseases.      Lack   of   self-control   endangers      _. 

13lS6£LS6 

one's  life  ;  it  threatens  the  hfe  of  the  wife; 
it  endangers  the  life  of  the  mother;  it  imperils  the  life  and 
the  sanity  of  the  child.  From  the  medical  standpoint  it 
is  vitally  important  that  these  diseases  should  be  more 
fully  controlled  by  public  health  authorities,  that  facilities 
for  laboratory  diagnosis  should  be  furnished,  and  that  pro- 
vision should  be  made  for  dispensary  and  hospital  treat- 
ment. Concealment,  delay  in  securing  treatment,  and  resort 
to  advertising  quacks  and  charlatans  are  in  large  measure 
responsible  for  the  extent  of  the  damage  wrought  by  these 
infections. 

45 


Around  all  the  camps  of  England  and  France  the  great- 

est    enemy   of  the  soldier  is  the  diseased 

,,     ^  , ,.  prostitute.      Some  of  the  finest  British  and 

the  Soldier  i     •  ,         •        .      u  u  '  •      i 

colonial    regiments     have    been    seriously 

affected.  The  British  government  is 
now  taking  stern  measures  to  protect  its  soldiers  by 
the  establishment  of  health  zones,  and  the  keeping  of 
the  men  within  certain  bounds.  In  view  of  the  special 
temptations  which  will  surround  our  new  army  in  this 
country  and  on  the  continent,  the  most  earnest  efforts 
should  be  made  to  control  the  surroundings  of  encamp- 
ments in  this  regard. 

Lieutenant-Colonel  Frank  R.  Keefer,  in  his  text-book  on 
_   .  .  ,         "Military  Hygiene  and  Sanitation,"   says: 

__ .  .  "Venereal  infections  are  responsible  for  an 

.    ^.     ?!.  enormous  amount  of  sickness  in  the  army — 

Authonties  ,,  ^,  ^,  -"    , 

vastly    more   than    any    other   cause — and 

constitute  the  most  important  health  problem  with  which 

we  have  to  deal."     In  the  "Manual  of  Military  Hygiene,"  by 

Colonel    Valery   Havard,   the   author   points   out    that   on 

account  of  the  importance  of  this  question,  "soldiers  should 

be  taught  all  knowledge  deemed  necessary  and  useful  on 

the  subject.     For  instance,  that  sexual  intercourse  is  not 

necessary  for  the  attainment  of  the  best  physical  and  mental 

health,  and  that  a  strong,  manly  character  is  developed  only 

by  self-control  and  continence.     They  should  have  a  proper 

appreciation   of   the   prevalence   and   gravity   of    venereal 

diseases. 

"  Many  men  expose  themselves  thoughtlessly,  with  the 

impression  that,  at  the  worst,  a  few  days  in  hospital  will 

suffice   to   get   rid   of   the   consequences.      This   is   foolish 

and  dangerous  ignorance  which  officers,  especially  medical 

officers,  should  endeavor  to  dispel  by  a  few  plain  talks, 

demonstrating  to  them  the  many  complications  and  sequels 

of  gonorrhea  as  well  as  the  ravages  of  syphilis,  which  affect 

not  only  the  incontinent,  but,  through  matrimony,  many 

46 


innocent  women  and  children.  Let  them  know  that,  in 
the  opinion  of  gynecologists,  a  majority  of  the  hazardous 
surgical  operations  performed  upon  married  women  are 
made  necessaiy  in  consequence  of  gonorrheal  infection 
by  the  husband;  and  another  terrifying  fact,  that 
sj^philis,  so  far  as  absolutely  known,  is  not  only  directly 
transmitted  from  father  to  children,  but  the  sole  disease 
thus  transmitted,  as  it  were,  a  special  curse  upon  the 
human  race." 

jNIore  recent  studies  have  shown  that  the  proportion  of 
prostitutes  afflicted  with  venereal  disease  is  far  higher  than 
has  been  assumed  by  earlier  writers.  Dr.  Walker  in  an  in- 
vestigation in  Baltimore  found  over  90  per  cent,  of  a  group 
of  prostitutes  suffering  from  syphilis  alone. 

The  good  soldier  owes  to  his  country  today  his  full  meas- 
ure of  strength  and  vigor.  He  owes  to  his  country  of  the 
future  a  full  measure  of  strength  and  vitality  to  be  handed 
on  to  coming  generations.  Both  may  be  fatally  jeopardized 
by  a  moment  of  weak  self-indulgence. 

ACCIDENTS  AND  FIRST  AID 

Slight  cuts  and  scratches  should  be  washed  free  from  dirt, 

then  carefully  dried  and  painted    with    a  ^^  ^        j 

r^^i      *•    ^  ^    •    ]•         Tvi  •  Cuts  and 

little    tmcture    of    lodme.     More    serious  __,        , 

wounds  should  be  dressed  temporarily,  until 
the  doctor  can  attend  to  them,  by  covering  them  with  sur- 
geons' gauze  fastened  on  with  a  bandage.  A  deep  wound, 
particularly  if  produced  by  a  rusty  nail  or  other  dirty  object, 
should  always  receive  prompt  medical  attention;  so  should 
even  the  slightest  scratch,  if,  after  a  few  days,  it  is  red,  hot 
or  painful.  Any  wound  will  heal  without  much  pain  or 
redness  if  there  are  no  germs  in  it.  Remember  that  germs 
get  into  a  wound,  not  from  the  air,  but  from  dirty  things 
that  touch  it.  A  scratch  or  cut  should  never  be  touched 
with  anything  but  sterilized  surgeons'  gauze.  In  connec- 
47 


tion  with  automobile  accidents,  it  is  well  to  remember  that 
gasoline  is  a  good  disinfectant. 

If  the  blood  comes  from  a  wound  in  jets  or  spurts,  an 
artery  is  bleeding,  and  the  result  may  be  serious  if  the  flow  is 
not  checked.  Fortunately,  at  most  parts  of  the  body  the 
arteries  are  deeply  buried  in  the  flesh.  A  severed  artery 
calls  for  prompt  action.  Put  firm  pressure  close  to  the  bleed- 
ing part,  between  the  wound  and  the  heart.  In  case  the 
wound  is  in  the  arm  or  the  leg,  the  pressure  is  best  applied 
by  tying  a  knot  in  the  center  of  a  folded  handkerchief,  and 
laying  this  knot  over  the  artery.  Tie  it  loosely  around  the 
limb,  but  with  a  good  knot.  Place  a  stick  under  the  bandage 
and  twist  it  round  and  round  until  the  bandage  is  tight 
enough  to  stop  the  bleeding. 

The  pain  and  swelling  of  an  ordinary  bruise  will  be  much 

.  less  if  something  cold  is  placed  on  the  bruise 

ruises  an  ^^  ^^^^  ^^  ^^^^^^  ^^^  blood  away.     Ice  in  a 

prams  ^^^^^  ^^^  1^^  ^^^^  ^^^  ^j^-^  p^pp^gg^  qj.  simply 

a  cloth  wrung  out  in  cold  water. 

If  a  joint  has  been  sprained  (which  means  that  the  Uga- 
ments  that  hold  the  bones  together  have  been  strained  or 
torn),  the  same  treatment  with  cold  cloths  is  very  useful, 
and  should  be  kept  up  at  intervals  for  twelve  hours.  In 
old  and  enfeebled  patients,  hot  wet  cloths  are  better.  The 
injured  part  should  be  placed  as  high  as  possible,  so  as  to 
keep  the  blood  out  of  it. 

If  a  bone  is  broken,  medical  care  is,  of  course,  necessary. 

While  waiting  for  the  doctor,  the  only  thing 

'■^     ^  to  do  is  to  keep  the  broken  limb  in  as  com- 

^^^^  fortable  a  position  as  possible.     Above  all, 

do  not  let  the  linib  bend  at   the  place  where   the  bone  is 

broken,  because  that  gets  the  splinters  of  bone  out  of  place, 

and  may  drive  them  through  the  skin  and  lead  to  an  infected 

wound.     If  you  find  it  necessary  to  lift  a  broken  limb,  put 

one  hand  on  each  side  of  the  break  and  lift  it  with  both 

hands  at  the  same  time. 

48 


A  person  who  has  become  faint  and  dizzy  from  the  direct 
effect  of  strong  sunUght  shining  on  the  Sy^stroke  and 
head  should  be  placed  in  a  seated  position  Pros- 

in  the  shade.     His  clothing  should  be  loos-        ^ 
ened,  and  cold  water  poured  on  his  head,  or 
his  body  rubbed  with  bits  of  ice.     Cool  drinks  should  be 
given,  if  possible. 

Heat  prostration  due  to  excessive  heat  acting  on  the  whole 
body,  and  not  to  the  direct  sun's  rays,  should  be  treated 
somewhat  differently.  The  patient  should  be  laid  flat  on 
his  back  in  a  cool  place,  his  clothing  loosened,  and  his  hands 
and  feet  rubbed,  to  restore  the  circulation.  The  face  and 
body  should  be  bathed  in  warm  water  and  warm  drinks 
should  be  given. 

If  the  clothing  catches  fire,  there  is  only  one  thing  to  do, 

and  it  must  be  done  quickly:   smother  the      „ 

flame.     Fire  needs  plenty  of  oxygen,   and       -,.  th'np-  and 

if   a  person  whose   clothing  is   on  fire  is      -,      .  ..     .    , 
.  , ,  111  1    •  .       Treatment  or 

qmckly   and    closely   wrapped   in    a    coat,       „ 

shawl,  blanket,  or  rug,  the  fire  will  go  out. 

It  is  important  to  remember  to  wrap  the  cloth  from  above 

down.     If   the  Avrapping   is   done   from    below,   the   flames 

may  be   driven   up   and  inhaled  into  the  lungs  with  very 

serious   results.     If   your   clothing   catches   fire  when   you 

are  alone,  do  not  run  for  help,  but  lie  down  flat  and   roll 

over  and  over  on  the  floor  or  on  the  ground,  to  smother  the 

flames. 

In  the  case  of  a  slight  burn  which  only  reddens  the  skin 

without  forming  a  bhster,  the  pain  -will  be  lessened  if  the  air 

is  kept  from  the  burned  place.     A  paste  of  ordinary  baking 

soda  and  water  applied  to  the  burn  will  do  this,  or  carbolized 

vaseline,  or  any  grease,  like  lard,  may  be  used  instead.     The 

burn  should  then  be  covered  by  tying  a  piece  of  cloth  or 

bandage   around   it.     If  there   is   extensive  blistering,   the 

application  of  soda  or  vaseline  may  do  harm;  and  severe 

burns  should  be  treated  like  open  wounds. 

49 


If  ears,  nose,  or  fingers  are  frost-bitten,  the  affected  part 
p,        ,  .  should  be  rubbed  with  snow  or  very  cold 

water  until  the  blood  has  come  back  and 
the  flesh  begins  to  sting  and  burn.  On  no  account  should 
the  person  go  into  a  warm  room  until  this  has  been  done,  and 
until  the  frozen  part  has  become  gradually  warm  by  rubbing. 
Even  after  the  circulation  has  come  back,  the  patient  should 
become  waraa  only  gradually. 

When  a  person  has  been  under  the  water  or  in  some  suffo- 

_  .  J     eating  gas  for  a  long  time,  the  breathing 

Drowmngand      ,  , -,         ^-    fu  • 

„   „       .  stops,  and  the  patient  becomes  unconscious. 

If  breathing  can  somehow  be  started  again, 
recovery  may  follow.  The  starting  of  the  breathing  move- 
ments in  a  person  who  has  ceased  to  make  them  for  himself 
is  called  artificial  respiration. 

Artificial  respiration  should  be  begun  by  laying  the  patient 
face  downward  upon  the  ground.  The  feet  should  be  raised 
to  drain  out  any  excess  water.  Stretch  the  arms  of  the 
patient  straight  above  his  head  and  let  them  rest  on  the 
ground  in  that  position.  Turn  his  head  a  little  to  one  side, 
so  that  the  air  will  not  be  impeded  in  entering  the  nose  and 
mouth.  Next  stand  astride  of  the  patient,  with  your  body 
directly  over  his  hips  and  facing  his  head.  Put  your  hands 
on  each  side  of  his  back,  below  the  shoulder  blades.  Your 
hands  now  rest  upon  the  patient's  lower  ribs.  The  fingers 
are  spread  out,  pointed  toward  the  head  and  away  from  the 
spine. 

Swing  your  body  forward,  keeping  your  arms  straight  and 
allowing  your  weight  to  rest  on  the  patient's  back;  then 
swing  back,  taking  all  your  weight  off  the  patient.  Do  this 
fourteen  or  sixteen  times  per  minute.  This  imitates  the 
motions  of  breathing.  When  you  put  your  weight  on  the 
patient,  you  press  his  chest  together  and  force  the  air  from 
the  lungs;  when  you  release  the  pressure,  the  chest  springs 
back  into  place,  and  the  lungs  expand  and  draw  air  into 
them. 

50 


Recovery  may  be  very  slow;  keep  up  your  work  for  at  leiist 
two  hours. 

While  this  process  is  going  on,  some  one  should  remove  the 
patient's  clothing.  If  necessary,  he  should  be  dried  with  a 
towel  and  then  covered  with  a  blanket.  This  work  must 
not  interfere  with  the  operator  who  is  causing  artificial 
respiration.  Compel  bystanders  to  stand  back.  The  patient 
needs  every  bit  of  air  he  can  get. 

When  the  patient  begins  to  breathe, — ^but  not  before, — he 
should  have  his  legs  and  arms  rubbed  toward  the  body. 
This  should  be  done  without  removing  the  blanket.  The 
patient  will  not  breathe  well  all  at  once,  and  it  will  be  neces- 
sary to  help  him  at  first  by  continuing  the  artificial  respira- 
tion every  little  while.  Of  course,  if  he  stops  breathing  at 
any  time,  the  artificial  respiration  must  be  renewed. 

After  he  is  breathing  well,  put  him  to  bed.  Surround  him 
with  hot  water-bottles  and  cover  him  up  well.  As  soon  as 
he  can  swallow,  give  him  some  hot  coffee.  Open  the  win- 
dows wide,  and  allow  him  to  sleep  quietly. 

Cases  of  electric  shock  (from  contact  with  live  wires,  for 
example)  and  cases  of  gas  poisoning  require  the  same  treat- 
ment— artificial  respiration. 

If  some  poisonous  drug  has  been  taken,  the  first  thing  to 

do  is  usually  to  get  it  out  of  the  body  again  -^  . 

•  11  1 1    u  x-  Poisons 

as  quickly  as  possible  by  causing  vomiting. 

This  may  be  done  by  running  the  finger  down  the  throat,  by 

drinking  a  large  quantity  of  warm  water,  or  by  taking  some 

substance  which  will  cause  vomiting,  called  an  emetic.     A 

teaspoonful  of  mustard  or  salt  in  a  glass  of  lukewarm  water 

will  serve  as  an  emetic.     Promptness  is  more  important  than 

an  exact  dose.     After  the  emetic   has   been  taken,   large 

quantities  of  warm  water  should  be  drunk,  to  dilute  the  poison 

that  remains. 


51 


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